AAPC OFFICIAL CPC CERTIFICATION EXAM
2025 /2026 WITH 100% ACCURATE ANSWERS
1. What is the primary purpose of a hold harmless clause in health plan
contracts?
Allows providers to charge patients for all services rendered.
Prohibits billing to patient for anything beyond deductibles and
co-pays.
Mandates that all health plans cover pre-existing conditions.
Ensures patients receive full reimbursement for all medical expenses.
2. In a scenario where a patient presents with symptoms that do not fit a
specific diagnosis, how should a coder appropriately use the term NOS?
The coder should use NOS to indicate the lack of a more specific
diagnosis.
The coder should assign a random diagnosis code.
The coder should consult a physician for a more specific code.
The coder should omit the diagnosis entirely.
3. What was the published conversion factor for the calendar year 2012 in
health care reform?
$30.1234
$34.0376
$36.7890
$32.4567
,4. What does the term 'excludes' indicate in coding practices?
Terms following 'excludes' notes are to be reported with a code
from another category.
Terms following 'excludes' notes indicate a related condition.
Terms following 'excludes' notes are synonymous with the primary
code.
Terms following 'excludes' notes are optional and can be ignored.
5. Describe the significance of the first four digits in a morphology code
within the context of health care coding.
The first four digits categorize the neoplasm by its size, which is
important for staging.
The first four digits of a morphology code indicate the histological
type of the neoplasm, which is crucial for accurate diagnosis and
treatment planning.
The first four digits provide information about the patient's age,
which is relevant for treatment decisions.
The first four digits represent the location of the neoplasm, which
helps in determining treatment options.
6. If the conversion factor for CY 2013 increased to $35.0000, how would this
change potentially affect a health care provider's reimbursement for
services rendered?
Reimbursement amounts for services would likely increase due to
the higher conversion factor.
Reimbursement amounts would only change for outpatient services.
, Reimbursement amounts would decrease because of the higher
conversion factor.
There would be no effect on reimbursement amounts.
7. What does Volume 3 of the ICD-9-CM specifically focus on?
Procedures performed in the outpatient setting
Diagnostic codes for outpatient services
Procedures performed in the inpatient setting
Billing practices for health insurance
8. What is Medicaid?
a charitable organization that provides healthcare in foreign
countries
an insurance program that provides unemployment benefits
a pet insurance program
a public assistance program designed to provide health care to
low-income persons
9. What are the key actions included in the OIG Compliance Program for
Individual and Small Group Physician Practices?
Conduct appropriate training and education of standards and
procedures.
Designate a compliance officer or contact to monitor compliance
efforts and enforce practice standards.
Implement compliance and practice standards through the
development of written standards and procedures.
, 10. Describe the significance of Appendix D in relation to health care reform
and its impact on employment injuries.
Appendix D outlines the coding systems used for billing.
Appendix D provides statistical information that can help in
understanding trends related to employment injuries.
Appendix D is primarily focused on patient treatment protocols.
Appendix D serves as a guideline for compliance in health care
practices.
11. All of the following describe the Affordable Care Act regarding fraud and
abuse EXCEPT
enhanced oversight of new providers
developed joint fraud strike forces
a sharing database across state and federal programs
required provider screening
12. Describe the significance of the conversion factor in the context of health
care reimbursement.
The conversion factor sets the maximum allowable charges for all
health care services.
The conversion factor is used to determine payment rates for
services under Medicare, impacting reimbursement amounts.
The conversion factor is irrelevant to health care reimbursement
processes.
The conversion factor only applies to private insurance plans, not
Medicare.
2025 /2026 WITH 100% ACCURATE ANSWERS
1. What is the primary purpose of a hold harmless clause in health plan
contracts?
Allows providers to charge patients for all services rendered.
Prohibits billing to patient for anything beyond deductibles and
co-pays.
Mandates that all health plans cover pre-existing conditions.
Ensures patients receive full reimbursement for all medical expenses.
2. In a scenario where a patient presents with symptoms that do not fit a
specific diagnosis, how should a coder appropriately use the term NOS?
The coder should use NOS to indicate the lack of a more specific
diagnosis.
The coder should assign a random diagnosis code.
The coder should consult a physician for a more specific code.
The coder should omit the diagnosis entirely.
3. What was the published conversion factor for the calendar year 2012 in
health care reform?
$30.1234
$34.0376
$36.7890
$32.4567
,4. What does the term 'excludes' indicate in coding practices?
Terms following 'excludes' notes are to be reported with a code
from another category.
Terms following 'excludes' notes indicate a related condition.
Terms following 'excludes' notes are synonymous with the primary
code.
Terms following 'excludes' notes are optional and can be ignored.
5. Describe the significance of the first four digits in a morphology code
within the context of health care coding.
The first four digits categorize the neoplasm by its size, which is
important for staging.
The first four digits of a morphology code indicate the histological
type of the neoplasm, which is crucial for accurate diagnosis and
treatment planning.
The first four digits provide information about the patient's age,
which is relevant for treatment decisions.
The first four digits represent the location of the neoplasm, which
helps in determining treatment options.
6. If the conversion factor for CY 2013 increased to $35.0000, how would this
change potentially affect a health care provider's reimbursement for
services rendered?
Reimbursement amounts for services would likely increase due to
the higher conversion factor.
Reimbursement amounts would only change for outpatient services.
, Reimbursement amounts would decrease because of the higher
conversion factor.
There would be no effect on reimbursement amounts.
7. What does Volume 3 of the ICD-9-CM specifically focus on?
Procedures performed in the outpatient setting
Diagnostic codes for outpatient services
Procedures performed in the inpatient setting
Billing practices for health insurance
8. What is Medicaid?
a charitable organization that provides healthcare in foreign
countries
an insurance program that provides unemployment benefits
a pet insurance program
a public assistance program designed to provide health care to
low-income persons
9. What are the key actions included in the OIG Compliance Program for
Individual and Small Group Physician Practices?
Conduct appropriate training and education of standards and
procedures.
Designate a compliance officer or contact to monitor compliance
efforts and enforce practice standards.
Implement compliance and practice standards through the
development of written standards and procedures.
, 10. Describe the significance of Appendix D in relation to health care reform
and its impact on employment injuries.
Appendix D outlines the coding systems used for billing.
Appendix D provides statistical information that can help in
understanding trends related to employment injuries.
Appendix D is primarily focused on patient treatment protocols.
Appendix D serves as a guideline for compliance in health care
practices.
11. All of the following describe the Affordable Care Act regarding fraud and
abuse EXCEPT
enhanced oversight of new providers
developed joint fraud strike forces
a sharing database across state and federal programs
required provider screening
12. Describe the significance of the conversion factor in the context of health
care reimbursement.
The conversion factor sets the maximum allowable charges for all
health care services.
The conversion factor is used to determine payment rates for
services under Medicare, impacting reimbursement amounts.
The conversion factor is irrelevant to health care reimbursement
processes.
The conversion factor only applies to private insurance plans, not
Medicare.
