MO Metrix CCS Exam Practice Test / Questions &
Detailed Solutions.
Which of the following is not a covered entity in the HIPAA Privacy rule?
a. The Centers for Disease Control and Prevention
b. Employer-sponsored health plan
c. Third-party billing agency
d. Healthcare provider - (ANSWER)a. The Centers for Disease Control and
Prevention
Which of the following is a risk adjustment model used by Medicare to predict
health care costs and resource consumption of specific patient populations over
time?
a. Risk adjustment factor (RAF)
b. Diagnosis-related groups
c. Outcome and Assessment information set
d. Hierarchical condition category (HCC) coding - (ANSWER)d. Hierarchical
condition category (HCC) coding
CPT cod 20650 is a column 2 code that has a National Correct Coding Initiative
(NCCI) edit of 1 when paired with CPT code 21813. How would this be
interpreted?
,a. The two codes are inclusive of each other and can never be billed together.
b. If being billed together, only report one unit of each
c. The two codes are exclusive of each other and can never be billed together
d. The two codes can be billed together with an appropriate modifier -
(ANSWER)d. The two codes can be billed together with an appropriate modifier
Based on the following documentation, what would the overall medical decision-
making be?
Numbered of diagnosis or management options: Minimal
Amount and complexity of data: Moderate
Level of risk: Moderate
a. Straightforward
b. Low complexity
c. Moderate complexity
d. High complexity - (ANSWER)c. Moderate complexity
A patient was seen by her gynecologist to remove her intrauterine device. The
removal was attempted but terminated due to excessive bleeding. How should
the gynecologist report the encounter?
a. 58301-53
,b. 58301-52
c. 99212-25, 58301
d. 99212, 58301-59 - (ANSWER)a. 58301-53
A technician performs an ultrasound of a patient's thyroid at a privately owned
family practice immediately following her annual health screening. The primary
care physician determines that the images are normal and advises the patient to
return in one year. How should the primary care physician report the ultrasound?
a. 76536-26
b. 76536-TC
c. 76536
d. 76536-TC, 26 - (ANSWER)c. 76536
no modifier
Which type of edit identifies the maximum number of units that may be reported
for a CPT/HCPCS code that relates to an individual patient?
a. Medically unlikely edits
b. Add-on-code edits
c. Correspondence edits
d. Procedure-to-procedure coding edits - (ANSWER)a. Medically unlikely edits
, Which statement best describes a comorbidity?
a. Two or more life-threatening illnesses occurring at the same time
b. Three or more minor injuries occurring at the same time
c. Three or more chronic illness occurring at the same time
d. Two or more unrelated diseases occurring at the same time. - (ANSWER)d. Two
or more unrelated diseases occurring at the same time.
A healthcare employee happens to meet a well-known actor during a lunch break.
Unknown to the employee, the actor is currently admitted in the hospital and has
chosen to eat in the cafeteria to not feel cooped up any longer. The employee
takes a photo and shares it with his co-workers and social media. Which AHIMA
standard(s) of Ethical Coding has been violated?
a. Protect privacy and confidentiality; protect personal health information; and
use technology, data, and information resources in the way they are intended.
b. Respect the dignity of every person, put the welfare of persons before self-
interest.
c. Refuse to participate in unethical practices, privacy and confidentiality, respect
the dignity of every person
d. None, the act was unintentional - (ANSWER)a. Protect privacy and
confidentiality; protect personal health information; and use technology, data,
and information resources in the way they are intended.
Detailed Solutions.
Which of the following is not a covered entity in the HIPAA Privacy rule?
a. The Centers for Disease Control and Prevention
b. Employer-sponsored health plan
c. Third-party billing agency
d. Healthcare provider - (ANSWER)a. The Centers for Disease Control and
Prevention
Which of the following is a risk adjustment model used by Medicare to predict
health care costs and resource consumption of specific patient populations over
time?
a. Risk adjustment factor (RAF)
b. Diagnosis-related groups
c. Outcome and Assessment information set
d. Hierarchical condition category (HCC) coding - (ANSWER)d. Hierarchical
condition category (HCC) coding
CPT cod 20650 is a column 2 code that has a National Correct Coding Initiative
(NCCI) edit of 1 when paired with CPT code 21813. How would this be
interpreted?
,a. The two codes are inclusive of each other and can never be billed together.
b. If being billed together, only report one unit of each
c. The two codes are exclusive of each other and can never be billed together
d. The two codes can be billed together with an appropriate modifier -
(ANSWER)d. The two codes can be billed together with an appropriate modifier
Based on the following documentation, what would the overall medical decision-
making be?
Numbered of diagnosis or management options: Minimal
Amount and complexity of data: Moderate
Level of risk: Moderate
a. Straightforward
b. Low complexity
c. Moderate complexity
d. High complexity - (ANSWER)c. Moderate complexity
A patient was seen by her gynecologist to remove her intrauterine device. The
removal was attempted but terminated due to excessive bleeding. How should
the gynecologist report the encounter?
a. 58301-53
,b. 58301-52
c. 99212-25, 58301
d. 99212, 58301-59 - (ANSWER)a. 58301-53
A technician performs an ultrasound of a patient's thyroid at a privately owned
family practice immediately following her annual health screening. The primary
care physician determines that the images are normal and advises the patient to
return in one year. How should the primary care physician report the ultrasound?
a. 76536-26
b. 76536-TC
c. 76536
d. 76536-TC, 26 - (ANSWER)c. 76536
no modifier
Which type of edit identifies the maximum number of units that may be reported
for a CPT/HCPCS code that relates to an individual patient?
a. Medically unlikely edits
b. Add-on-code edits
c. Correspondence edits
d. Procedure-to-procedure coding edits - (ANSWER)a. Medically unlikely edits
, Which statement best describes a comorbidity?
a. Two or more life-threatening illnesses occurring at the same time
b. Three or more minor injuries occurring at the same time
c. Three or more chronic illness occurring at the same time
d. Two or more unrelated diseases occurring at the same time. - (ANSWER)d. Two
or more unrelated diseases occurring at the same time.
A healthcare employee happens to meet a well-known actor during a lunch break.
Unknown to the employee, the actor is currently admitted in the hospital and has
chosen to eat in the cafeteria to not feel cooped up any longer. The employee
takes a photo and shares it with his co-workers and social media. Which AHIMA
standard(s) of Ethical Coding has been violated?
a. Protect privacy and confidentiality; protect personal health information; and
use technology, data, and information resources in the way they are intended.
b. Respect the dignity of every person, put the welfare of persons before self-
interest.
c. Refuse to participate in unethical practices, privacy and confidentiality, respect
the dignity of every person
d. None, the act was unintentional - (ANSWER)a. Protect privacy and
confidentiality; protect personal health information; and use technology, data,
and information resources in the way they are intended.
