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Medical Coding Expert Guide (100+ Q&A) – ICD-9/10, CPT, HCPCS, Guidelines, Compliance | 2025/2026

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This expert-verified resource contains over 100 in-depth questions and answers covering the foundations, systems, and regulatory frameworks of medical coding, tailored for 2025/2026 students and professionals preparing for certification exams. The material is structured around core coding systems—ICD-9-CM, ICD-10-CM/PCS, CPT, and HCPCS Levels I & II—as well as the agencies, tools, and legal requirements essential for coders working in outpatient and inpatient healthcare settings. Major topics include: Key organizations and agencies: CMS, AAPC, AHIMA, BAMC, HIAA, and their roles in credentialing, regulation, and coding policy ICD-9 and ICD-10 coding systems: Structure, volumes, classification levels, alphanumeric categories, V/E/M codes, main terms, sequencing rules, coding guidelines, and transition to ICD-10 CPT and HCPCS: Category I, II, III codes, modifiers, CPT appendices, Level II national codes, and examples of procedural and service coding Coding conventions: Use of brackets, slanted brackets, braces, cross-references, code also, see/see also, excludes/includes notes, fifth-digit subclassifications Insurance fraud vs. abuse, and compliance mandates under HIPAA, OBRA, and the False Claims Act Medical necessity & documentation: Evaluation and Management (E/M) coding, SOAP format, operative reports, symptoms vs. signs, and coding canceled procedures Procedural coding & inpatient focus: ICD-9-CM Volume 3 usage, diagnostic justification, and rules for principal vs. first-listed diagnosis This guide is best suited for: Students preparing for CPC, CCS, or CCA exams HIM and HIT learners studying comprehensive coding practices Medical billing/coding professionals reviewing compliance and regulatory detail Instructors and tutors building foundational coding lesson plans Clear, organized, and aligned with industry standards, this document bridges practical coding application with legal and procedural accuracy. Keywords: ICD-10-CM, ICD-9-CM, CPT, HCPCS, coding compliance, medical necessity, coding guidelines, V codes, E codes, M codes, procedural coding, AAPC, AHIMA, CMS, BAMC, diagnosis coding, SOAP notes, CPT modifiers, inpatient coding, outpatient coding, coding fraud, coding sequencing

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Geüpload op
16 januari 2026
Aantal pagina's
19
Geschreven in
2025/2026
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Medical Coding 2025 Expert Verified |
Ace the Test



Centers for Medicare & Medicaid Services (CMS) - 🧠ANSWER ✔✔An

administrative agency within the Department of Health and Human

Services (DHHS) that oversees Medicare, Medicaid, and other government

programs. Formerly known as the Health Care Financing Administration

(HCFA)


American Academy of Professional Coders (AAPC) - 🧠ANSWER ✔✔The

professional association for medical coders providing ongoing education,

certification, networking and recognition, with certifications for coders in

physicians' offices and hospital outpatient facilities

,American Health Information Management Association (AHIMA) -

🧠ANSWER ✔✔One of the four co-operationg parties for ICD-9-CM.

Professional association for over 38,000 Health Information Management

Professionals throughout the country


Board of Advanced Medical Coding (BAMC) - 🧠ANSWER ✔✔An

organization of coders, clinicians, and compliance professionals dedicated

to the evaluation, recognition, and career advancement of professional

medical coders within physician practices, facility and post-acute settings


Board of Advanced Medical Coding (BMAC) - 🧠ANSWER ✔✔provides

specialty certification for::

Anesthesia/Pain Management, Cardiology, Dermatology,

Facility Outpatient/ Ambulatory Surgical Center, Family Practice/Pediatrics,

Gastroenterology, General Surgery, Obstetrics/Gynecology,

Ophthalmology, Orthopedics, Radiology, Urology

Health Insurance Portability and Accountability Act (HIPAA) - 🧠ANSWER

✔✔Mandates regulations that govern privacy, security, and electronic

transactions standards for health care information

, insurance fraud - 🧠ANSWER ✔✔intentional, deliberate misrepresentation of

information for profit or to gain some unfair or dishonest advantage


Health Insurance Association of America (HIAA) - 🧠ANSWER ✔✔An

agency providing statistics and resources for public health information

which includes diseases, pregnancies, aging, and mortality.


insurance abuse - 🧠ANSWER ✔✔inconsistent activities considered

unacceptable business practice


Omnibus Budget Reconciliation Act (OBRA) - 🧠ANSWER ✔✔A federal law

outlining numerous areas of healthcare, establishing guidelines and

penalties


tools of the trade for coders - 🧠ANSWER ✔✔current: ICD-9-CM manual

issued every October, CPT manual issued every January, HCPCS manual

issued every January, medical dictionary w/ supplement for medical

abbreviations and acronyms, carrier bulletins, newsletters, and websites

Healthcare Common Procedure Coding System (HCPCS) - 🧠ANSWER

✔✔coding system that consists of CPT and national codes (level II), used

to identify procedures, supplies, medications (except vaccines), and

equipment. pronounced hick picks.


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