ESTUDYR
CERTIFIED PROFESSIONAL CODER (CPC) CERTIFICATION
MULTICHOICE ANSWERED EXAM QUESTIONS WITH DETAILED
RATIONALE
Coding is:
A. The act of prescribing medications
B. The process of translating spoken language into speech
C. C. The process of translating a written or dictated medical record into a series of numeric or
alphanumeric codes ✔
D. Only used for billing nonmedical services
Rationale: Coding converts clinical documentation into standardized codes for billing, statistics,
and records.
Proper code assignment is determined by:
A. Insurance company preferences only
B. The most expensive procedure listed
C. C. The content of the medical record and the unique rules that govern each code set ✔
D. What the patient requests
Rationale: Codes must reflect documentation and adhere to the coding system rules (ICD, CPT,
HCPCS).
Which three things must coders master?
A. Pharmacology, lab techniques, billing software
B. Psychology, ethics, anatomy
C. C. 1) Anatomy 2) Medical terminology 3) Attention to detail ✔
D. Surgery, nursing, radiology
Rationale: Accurate coding depends on anatomical knowledge, correct terminology, and
meticulous attention to documentation detail.
Medical coders assign a code to:
A. The patient’s insurance only
B. Operating room equipment
C. C. 1) Each diagnosis 2) Services/procedures 3) Supplies (using classification systems when
applicable) ✔
D. Pharmacy inventory only
Rationale: Coding covers diagnoses, services rendered, and billable supplies.
,ESTUDYR
The classification system determines:
A. Hospital visiting hours
B. Physician schedules
C. C. The amount healthcare providers will be reimbursed by payers using the system (e.g.,
Medicare) ✔
D. Patient satisfaction scores
Rationale: Payment systems (DRGs, APCs) link coded services to reimbursement.
A coder evaluates the medical record for:
A. Only dates and signatures
B. Cosmetic descriptions
C. C. 1) Completeness and accuracy 2) Whether clarification from clinicians is needed ✔
D. Stock levels of supplies
Rationale: Coders ensure documentation supports the codes; they query providers when info is
missing/unclear.
Technicians who specialize in coding inpatient hospital services are commonly called:
A. Lab technicians
B. Billing clerks only
C. C. Health information coders / medical record coders / coders-abstractors / coding
specialists ✔
D. Physical therapists
Rationale: Inpatient-focused coding roles have these professional titles.
MS-DRGs stands for:
A. Medical Service — Drug Related Group
B. Multi-System — Diagnosis Related Guidelines
C. C. Medicare Severity — Diagnosis Related Groups ✔
D. Managed Services — Diagnosis Rate Group
Rationale: MS-DRGs group inpatient cases by clinical similarity and resource use for Medicare
payment.
MS-DRGs are used to:
A. Schedule operating rooms
B. Determine clinical protocols only
C. C. Determine hospital reimbursement amounts for Medicare/other payers using DRG
methodology ✔
D. Track nursing shifts
Rationale: DRG assignment determines the prospective payment for inpatient stays.
,ESTUDYR
EHR stands for:
A. Electronic Hospital Regulation
B. Emergency Health Report
C. C. Electronic Health Record ✔
D. External Health Registry
Rationale: EHR is the digital record of a patient’s health information.
Skilled coders can advance to become:
A. Only front desk staff
B. Pathologists
C. C. Consultants, educators, or medical auditors ✔
D. Radiology technologists
Rationale: Experienced coders often move into auditing, education, or consulting roles.
The primary difference between hospital and physician services coding is:
A. There is none — they use the same exact rules
B. Hospitals only code medications
C. C. Outpatient/physician coding emphasizes CPT, HCPCS, ICD-10-CM Vols 1 & 2;
inpatient/hospital coding adds ICD-10-CM Vol 3 and MS-DRGs ✔
D. Physicians do not use ICD codes
Rationale: Coding scope and applicable code sets differ by setting.
APC refers to:
A. Advanced Procedure Code
B. Annual Procedure Chart
C. C. Ambulatory Payment Classification — used by outpatient facility coders (prospective
payment for outpatient services) ✔
D. Acute Patient Care scale
Rationale: APCs determine outpatient facility reimbursement under Medicare outpatient
prospective payment.
The coder’s role in a physician’s office is:
A. Minor and nonessential
B. Only to schedule appointments
C. C. Extremely important to ensure proper reimbursement and the financial livelihood of the
physician ✔
D. To perform clinical examinations
Rationale: Accurate coding directly impacts provider payment and compliance.
, ESTUDYR
A typical physician’s education includes:
A. 2 years of college only
B. Only technical school
C. C. 4 years of college + 4 years of medical school + 3–5 years of residency ✔
D. A single certification course
Rationale: Physicians follow an extended education and residency training path.
Mid-level providers (physician extenders) include:
A. Medical coders and auditors
B. Surgeons and anesthesiologists only
C. C. Physician assistants (PAs) and nurse practitioners (NPs) ✔
D. Clerical staff
Rationale: PAs and NPs provide many physician functions under varying supervision.
Typical PA training requirements include:
A. A 2-week course only
B. No formal education required
C. C. Around 26+ months of training (program lengths vary) and state licensure; practice
under physician supervision ✔
D. A PhD in medicine
Rationale: PA programs are intensive, collegiate-level training culminating in licensure.
A nurse practitioner must have:
A. A high school diploma only
B. A physician’s license
C. C. A master’s degree in nursing (or higher) plus certification and state licensure ✔
D. A paramedic certificate
Rationale: NPs require graduate-level nursing education and credentialing.
Commercial carriers are:
A. Government programs only
B. Only dental insurers
C. C. Private payers offering group and individual insurance plans ✔
D. Hospital-owned facilities only
Rationale: Commercial insurers are private entities providing health plans.
In the simplest form, how many payer types exist?
A. Five
B. Ten
C. C. Two — private insurance plans and government insurance plans ✔
CERTIFIED PROFESSIONAL CODER (CPC) CERTIFICATION
MULTICHOICE ANSWERED EXAM QUESTIONS WITH DETAILED
RATIONALE
Coding is:
A. The act of prescribing medications
B. The process of translating spoken language into speech
C. C. The process of translating a written or dictated medical record into a series of numeric or
alphanumeric codes ✔
D. Only used for billing nonmedical services
Rationale: Coding converts clinical documentation into standardized codes for billing, statistics,
and records.
Proper code assignment is determined by:
A. Insurance company preferences only
B. The most expensive procedure listed
C. C. The content of the medical record and the unique rules that govern each code set ✔
D. What the patient requests
Rationale: Codes must reflect documentation and adhere to the coding system rules (ICD, CPT,
HCPCS).
Which three things must coders master?
A. Pharmacology, lab techniques, billing software
B. Psychology, ethics, anatomy
C. C. 1) Anatomy 2) Medical terminology 3) Attention to detail ✔
D. Surgery, nursing, radiology
Rationale: Accurate coding depends on anatomical knowledge, correct terminology, and
meticulous attention to documentation detail.
Medical coders assign a code to:
A. The patient’s insurance only
B. Operating room equipment
C. C. 1) Each diagnosis 2) Services/procedures 3) Supplies (using classification systems when
applicable) ✔
D. Pharmacy inventory only
Rationale: Coding covers diagnoses, services rendered, and billable supplies.
,ESTUDYR
The classification system determines:
A. Hospital visiting hours
B. Physician schedules
C. C. The amount healthcare providers will be reimbursed by payers using the system (e.g.,
Medicare) ✔
D. Patient satisfaction scores
Rationale: Payment systems (DRGs, APCs) link coded services to reimbursement.
A coder evaluates the medical record for:
A. Only dates and signatures
B. Cosmetic descriptions
C. C. 1) Completeness and accuracy 2) Whether clarification from clinicians is needed ✔
D. Stock levels of supplies
Rationale: Coders ensure documentation supports the codes; they query providers when info is
missing/unclear.
Technicians who specialize in coding inpatient hospital services are commonly called:
A. Lab technicians
B. Billing clerks only
C. C. Health information coders / medical record coders / coders-abstractors / coding
specialists ✔
D. Physical therapists
Rationale: Inpatient-focused coding roles have these professional titles.
MS-DRGs stands for:
A. Medical Service — Drug Related Group
B. Multi-System — Diagnosis Related Guidelines
C. C. Medicare Severity — Diagnosis Related Groups ✔
D. Managed Services — Diagnosis Rate Group
Rationale: MS-DRGs group inpatient cases by clinical similarity and resource use for Medicare
payment.
MS-DRGs are used to:
A. Schedule operating rooms
B. Determine clinical protocols only
C. C. Determine hospital reimbursement amounts for Medicare/other payers using DRG
methodology ✔
D. Track nursing shifts
Rationale: DRG assignment determines the prospective payment for inpatient stays.
,ESTUDYR
EHR stands for:
A. Electronic Hospital Regulation
B. Emergency Health Report
C. C. Electronic Health Record ✔
D. External Health Registry
Rationale: EHR is the digital record of a patient’s health information.
Skilled coders can advance to become:
A. Only front desk staff
B. Pathologists
C. C. Consultants, educators, or medical auditors ✔
D. Radiology technologists
Rationale: Experienced coders often move into auditing, education, or consulting roles.
The primary difference between hospital and physician services coding is:
A. There is none — they use the same exact rules
B. Hospitals only code medications
C. C. Outpatient/physician coding emphasizes CPT, HCPCS, ICD-10-CM Vols 1 & 2;
inpatient/hospital coding adds ICD-10-CM Vol 3 and MS-DRGs ✔
D. Physicians do not use ICD codes
Rationale: Coding scope and applicable code sets differ by setting.
APC refers to:
A. Advanced Procedure Code
B. Annual Procedure Chart
C. C. Ambulatory Payment Classification — used by outpatient facility coders (prospective
payment for outpatient services) ✔
D. Acute Patient Care scale
Rationale: APCs determine outpatient facility reimbursement under Medicare outpatient
prospective payment.
The coder’s role in a physician’s office is:
A. Minor and nonessential
B. Only to schedule appointments
C. C. Extremely important to ensure proper reimbursement and the financial livelihood of the
physician ✔
D. To perform clinical examinations
Rationale: Accurate coding directly impacts provider payment and compliance.
, ESTUDYR
A typical physician’s education includes:
A. 2 years of college only
B. Only technical school
C. C. 4 years of college + 4 years of medical school + 3–5 years of residency ✔
D. A single certification course
Rationale: Physicians follow an extended education and residency training path.
Mid-level providers (physician extenders) include:
A. Medical coders and auditors
B. Surgeons and anesthesiologists only
C. C. Physician assistants (PAs) and nurse practitioners (NPs) ✔
D. Clerical staff
Rationale: PAs and NPs provide many physician functions under varying supervision.
Typical PA training requirements include:
A. A 2-week course only
B. No formal education required
C. C. Around 26+ months of training (program lengths vary) and state licensure; practice
under physician supervision ✔
D. A PhD in medicine
Rationale: PA programs are intensive, collegiate-level training culminating in licensure.
A nurse practitioner must have:
A. A high school diploma only
B. A physician’s license
C. C. A master’s degree in nursing (or higher) plus certification and state licensure ✔
D. A paramedic certificate
Rationale: NPs require graduate-level nursing education and credentialing.
Commercial carriers are:
A. Government programs only
B. Only dental insurers
C. C. Private payers offering group and individual insurance plans ✔
D. Hospital-owned facilities only
Rationale: Commercial insurers are private entities providing health plans.
In the simplest form, how many payer types exist?
A. Five
B. Ten
C. C. Two — private insurance plans and government insurance plans ✔
