Medical Billing and Coding Review Questions
Course Introduction
Medical Billing and Coding is an essential course that introduces students to the foundational concepts and practices involved in the processing of healthcare claims and the assignment of codes for medical diagnoses, procedures, and services. Students will learn about various coding systems such as ICD, CPT, and HCPCS, and develop proficiency in accurately translating medical records into standardized codes used for billing and insurance purposes. The course also covers key aspects of healthcare documentation, compliance with government regulations like HIPAA, and reimbursement procedures. Practical exercises reinforce skills in claim submission, error resolution, and the ethical responsibilities of medical billing professionals, preparing students for roles in medical offices, hospitals, and insurance companies.
Recommended Textbook
ICD 10 CM PCS Coding Theory and Practice 2016 Edition 1st Edition by Karla R. Lovaasen
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1674 Verified Questions
1674 Flashcards
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Chapter 1: The Rationale for and History of Coding
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46 Flashcards
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Sample Questions
Q1) NCHS
A)American Academy of Professional Coders
B)Certified Coding Specialist
C)American Hospital Association
D)National Center for Health Statistics
E)Registered Health Information Technician
Answer: D
Q2) Coded data are used for various purposes.List three of these purposes.
Answer: Coded data are used to purchase more equipment,add an operating room,hire additional staff,or gain additional skills,or for reimbursement purposes,risk management,quality improvement,or nursing clinical pathways.
Q3) WHO stands for __________.
Answer: World Health Organization
Q4) Both AHIMA and AAPC have standards for ethical coding.
A)True
B)False
Answer: True
Q5) To maintain their credentials,coders must earn __________.
Answer: continuing education units
CEUs
3
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Chapter
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Sample Questions
Q1) UHDDS
A)Centers for Medicare and Medicaid Services
B)Temperature,pulse,and respiration
C)Uniform Hospital Discharge Data Set
D)Gastroesophageal reflux disease
Answer: C
Q2) What are three of the five purposes of a health record?
Answer: The following are purposes of a health record: Describes the patient's health history
Serves as a method for clinicians to communicate regarding the treatment plan of care for the patient
Serves as a legal document of care and services provided
Serves as a source of data
Serves as a resource for healthcare practitioner education
Q3) A query should contain all of the following items EXCEPT ____.
A)date of service
B)amount of increased reimbursement due to query
C)patient name
D)area for provider signature
Answer: B
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Chapter 3: ICD-10-Cm Format and Conventions
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Sample Questions
Q1) The word "__________" in the Alphabetic Index is sequenced immediately following the main term,not in alphabetic order.
Answer: with
Q2) An "Excludes1 note" under a code indicates that the terms excluded from the code are to be coded elsewhere.
A)True
B)False
Answer: True
Q3) The bolded subterm in the diagnostic statement bacterial pneumonia is a(n) ____ modifier.
A)essential
B)nonessential
Answer: A
Q4) In ICD-10-CM,the final character of a code assignment can never be a letter.
A)True
B)False
Answer: False
Q5) Why is it important for the coder to understand coding conventions?
Answer: Ensures accurate assignment and sequencing of codes
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Chapter 4: Basic Steps of Coding
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Sample Questions
Q1) The __________,if available,is the first step in the process of record review for code selection.
Q2) Once a code has been selected from the Alphabetic Index to Diseases,what is the next step?
Q3) Once a code has been selected from the Alphabetic Index,it must be verified in this
A)Tabular List
B)See also
C)Subterms
D)Discharge summary
E)Coding Clinic
F)ER
G)Differential diagnosis
H)Chief complaint
I)The first basic step in coding the principal diagnosis
J)Nonessential modifiers
Q4) What is the main term in "aspiration pneumonia"?
Q5) What is the main purpose of the Alphabetic Index in ICD-10-PCS?
Q6) What is the subterm in "aspiration pneumonia"?
Q7) What is the subterm in "rheumatoid arthritis"?
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Chapter 5: General Coding Guidelines for Diagnosis
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Sample Questions
Q1) Etiology/manifestation convention requires ____ code(s) to fully describe a single condition that affects multiple body systems.
A)one
B)two
C)three
D)zero
Q2) If the principal diagnosis was abdominal pain due to acute appendicitis,the abdominal pain would be coded as a secondary diagnosis.
A)True
B)False
Q3) What is the diagnosis code(s) for acute and chronic bronchitis?
Q4) The selection of codes A00.0 through Z99.89 will NOT be used frequently to describe the reason for the admission/encounter.
A)True
B)False
Q5) What is the diagnosis code(s) for acute and chronic renal failure?
Q6) What is the diagnosis code(s) for thoracolumbar scoliosis (neuromuscular) due to past history of poliomyelitis?
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Chapter 6: General Coding Guidelines for Medical and Surgical Procedures
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Sample Questions
Q1) A character "X" is available to indicate that no qualifier is necessary for a given procedure.
A)True
B)False
Q2) Total lobectomy of right upper lobe lung,open approach
Q3) A bone marrow transplant is coded to the root operation transplant.
A)True
B)False
Q4) Right inguinal herniorrhaphy with synthetic mesh,open
Q5) The cystic duct is in what body system?
Q6) Cutting into a body part without draining fluids and/or gases from the body part in order to separate or transect a body part is called ____.
A)reattachment
B)release
C)transfer
D)division
Q7) ____________________ examinations and procedures are performed with an instrument that examines any cavity of the body with the use of a rigid or a flexible scope.
Q8) Diagnostic arthroscopy,right shoulder Page 8
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Chapter 7: General Coding Guidelines for Other Medical-
and Surgical-Related Procedures and Ancillary Procedures
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Sample Questions
Q1) The approach for chiropractic manipulation is always internal.
A)True
B)False
Q2) Fascial release of the cervical region-osteopathic treatment
Q3) The fourth character is the body part that is the focus of the radiation therapy.
A)True
B)False
Q4) The approach for an osteopathic treatment is always external.
A)True
B)False
Q5) The approach for an osteopathic treatment is always external.
A)True
B)False
Q6) Irrigation is a root operation that is found in the placement section.
A)True
B)False
Q7) Isotope is the seventh character qualifier in the radiation oncology section. A)True
B)False
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Chapter 8: Symptoms,
Signs, and Abnormal Clinical and Laboratory Findings Not Elsewhere Classified, and Z Codes
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Sample Questions
Q1) The patient is admitted to the hospital with fever and dehydration resulting from pneumonia.
A)J18.9,E86.0
B)J18.9,E86.0,R50.9
C)R50.9 J18.9,E86.0
D)J18.9,E86.1,R50.81
Q2) The patient was admitted to the hospital for monitoring of seizure like spells.Video electroencephalogram monitoring (external) of these episodes was performed and did not reveal any epileptic activity.Final Diagnosis: Transient alteration of awareness.Seizure disorder ruled out.
A)R40.4,4A10X4Z
B)R40.4,4A00X4Z
C)Z13.858,4A00X4Z
D)R40.4,Z13.858,4A10X4Z
Q3) Where are Z codes located in the Tabular List of the coding book?
Q4) Retained metal fragment: __________
Q5) Impending stroke with dizziness and facial weakness: __________
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Q6) Patient is admitted for workup of normal pressure hydrocephalus because of ataxic gait.NPH is ruled out,and patient is discharged home: __________
Chapter 9: Certain Infectious and Parasitic Diseases
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Sample Questions
Q1) If sepsis is present on admission and meets the definition of principal diagnosis,the systemic infection code should be assigned as the principal diagnosis.
A)True
B)False
Q2) The patient was admitted with septic shock and acute renal failure caused by a UTI due to Escherichia coli.Discharge summary states sepsis due to Escherichia coli.
A)N39.0,A45.51,N17.9,R65.21
B)A41.51,N39.0,R65.21,N17.9
C)R65.21,N39.0,A41.51,N17.9
D)A41.9,N39.0,N17.9,R65.10
Q3) Code B20 is NEVER used once a patient develops AIDS.
A)True
B)False
Q4) What virus is spread to individuals by a mosquito bite?
Q5) The CDC considers a patient to have AIDS if a CD4+ T-cell count is less than ___ cells/ml.
Q6) Assign the code for suspected carrier of group B strep.
Q7) Ebola virus.
Page 12
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Chapter 10: Neoplasms
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Sample Questions
Q1) Malignant growth of connective tissue
A)Well differentiated
B)Sarcomas
C)Fibromas
D)Metastasis
E)Leukemias
F)Melanomas
G)Carcinomas
H)Undifferentiated
I)Myeloma
J)Grading
K)Primary site
L)Staging
M)Adenocarcinoma
Q2) Patient was seen in the clinic for Burkitt's lymphoma.Patient is HIV positive.
A)B20,C83.79
B)C83.70,Z21
C)B20,C83.70
D)C83.79,B20
Q3) What is the abbreviation for small-cell lung cancer?
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Chapter 11: Diseases of the Blood and Blood-Forming
Organs and Certain Disorders Involving the Immune
Mechanism
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Sample Questions
Q1) When looking up anemic conditions in the code book,you should look up ____.
A)anemia first and then the various subterms
B)the type of anemia first and then "anemia" as a subterm
C)the symptoms that have presented
D)none of the above
Q2) A patient is being admitted for a total splenectomy (open approach) for treatment of idiopathic thrombocytopenic purpura.
A)D69.0,07BP0ZZ
B)D69.3,07TP4ZZ
C)D69.2,07TP4ZZ
D)D69.3,07TP0ZZ
Q3) A patient is admitted with thrombocytopenia and coagulopathy due to alcoholic cirrhosis of liver and alcohol dependence.Patient receives platelet transfusion via peripheral vein,percutaneous approach,and vitamin K.Patient's blood count improves before Patient is discharged.__________
Q4) Procedural complications affecting the spleen are included in Chapter 3 of ICD-10-CM.
Page 14
A)True
B)False
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Chapter 12: Endocrine, Nutritional, and Metabolic Diseases
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Sample Questions
Q1) Patient was admitted for a total (open) thyroidectomy.Patient had been having progressive symptoms with a substernal multinodular goiter.The procedure was performed as planned.Pathology confirmed a multinodular goiter.The patient was able to tolerate a solid food diet.
A)E04.0,0GBH0ZZ
B)E04.2,0GTK0ZZ
C)E04.2,0GTK4ZZ
D)E04.1,0GBK4ZZ
Q2) Hypoglycemia: __________
Q3) A patient is admitted because of cystic fibrosis with pulmonary exacerbation.Sputum cultures grew Pseudomonas,and antibiotics are adjusted accordingly.The patient is also treated for hypernatremia and dehydration.
A)E84.8,B96.5,E86.0,E87.0
B)E84.0,B96.5,E86.0,E87.0
C)E84.0,B96.4,E87.0
D)B96.5,E84.0,E86.0,E87.0
Q4) The correct abbreviation for phenylketonuria is ____________________.
Q5) What is exophthalmos?
Q6) Familial hypercholesterolemia: __________
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Chapter 13: Mental, Behavioral, and Neuro developmental Disorders
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Sample Questions
Q1) What drug could be given to treat depression?
A)Adderall
B)Zoloft
C)Valium
D)Dilantin
Q2) ICD-10-CM does not have a history code for history of drug or alcohol abuse.
A)True
B)False
Q3) Which of the following is NOT one of the five types of schizophrenia?
A)Undifferentiated
B)Paranoid
C)Manoliphic
D)Catatonic
Q4) The most common type of intellectual disability is the mild type,which affects ____ of those who have intellectual disabilities.
A)20%
B)50%
C)85%
D)100%
Q5) Panic agoraphobia:
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Eye and Adnexa,and Diseases of the Ear and Mastoid Process
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Sample Questions
Q1) Bilateral retrolental fibroplasia: __________
Q2) Decreased ocular pressure with papilledema: __________
Q3) An infection or inflammation of the meninges
A)Glaucoma
B)Hydrocephalus
C)Meningitis
D)Epilepsy
E)Parkinson's disease
F)Cataract
G)Cholesteatoma
H)Mastoiditis
I)Myasthenia gravis
J)Alzheimer's disease
Q4) A patient with trigeminal neuralgia and a history of migraine headaches is admitted for an open rhizotomy.A day after the procedure,the patient develops a severe headache diagnosed as a migraine.
A)G50.0,G43.901,008M3ZZ
B)G50.0,G43.909,008K0ZZ
C)G50.0,G43.901,008K0ZZ
D)G50.0,G43.909,008K4ZZ
Page 17
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Chapter 15: Diseases of the Circulatory System
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Sample Questions
Q1) Deep vein thrombosis (DVT) is a blood clot that forms deep in a vein,usually in the leg or hip.
A)True
B)False
Q2) The two main types of heart failure are systolic and diastolic.
A)True
B)False
Q3) The patient was admitted with left-sided hemiparesis due to a cerebrovascular accident.The patient has a history of previous CVA with residual facial droop.
A)I63.9,G81.94,I69.392
B)G81.94,I63.9,I69.892
C)I69.354,G81.94
D)163.9,Z86.73,G81.94
Q4) Patient presents with left carotid artery thrombosis with infarct and current right hemiparesis.Patient has residual aphasia from a previous stroke.
A)I69.854,I63.032,I69.320
B)I63.032,I69.032,I69.320
C)I63.032,G81.91,I69.320
D)I69.320,G81.90,I69.854
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Chapter 16: Diseases of the Respiratory System
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Sample Questions
Q1) Artificial opening status,tracheostomy
A)Z82.5
B)Z83.6
C)Z87.891
D)Z85.22
E)Z48.24
F)Z77.090
G)Z93.0
Q2) When pleural effusion results from trauma or disease and blood is accumulating in the pleural space,the condition is called ____.
A)hemothorax
B)empyema
C)chylothorax
D)none of the above
Q3) In relation to the respiratory system,what does RUL stand for?
A)Right upper lip
B)Reasonable upper length
C)Right upper lobe
D)Right upper lid
Q4) Cork handlers' disease: __________
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Chapter 17: Diseases of the Digestive System
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Sample Questions
Q1) The removal of the appendix
A)Nissen fundoplication
B)Herniorrhaphy
C)Appendectomy
D)Colostomy
E)Lysis of adhesions
F)PEG (percutaneous endoscopic gastrostomy)
G)TIPS (transjugular intrahepatic portosystemic shunt) procedure
H)Whipple procedure
Q2) An ileostomy is very similar to a(n) ____________________ EXCEPT that the end of the small intestine is brought through the abdominal wall.
Q3) A patient is admitted with recurrent right inguinal hernia.The hernia cannot be reduced,and the patient is taken to the OR for an open repair of indirect hernia with mesh.The patient spiked a fever on day 2,and workup reveals a UTI.What codes are applicable?
Q4) Recurrent gangrenous inguinal hernia: __________
Q5) Retrocecal abscess: __________
Q6) Assign the code for choledochoduodenal fistula: __________
Q7) What is an ulcer (such as of the stomach or intestine)?
Q8) Postgastrectomy diarrhea: __________
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Chapter 18: Diseases of the Skin and Subcutaneous Tissue
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Sample Questions
Q1) When dermatitis is caused by contact with a substance,it is called ____ dermatitis.
A)exogenous
B)endogenous
C)mesogenous
D)outer contact
Q2) Exfoliative dermatitis: __________
Q3) The outer layer of skin is called the ____________________.
Q4) Dead tissue usually associated with loss of vascular supply
A)Decubitus ulcer
B)Skin ulcers
C)Cellulitis
D)Stasis ulcer
E)Stasis dermatitis
F)Intertriginous dermatitis
G)Gangrene
H)Hives
I)Dermatitis
Q5) Asteatosis cutis: __________
Q6) The skin is composed of ____________________ layers.
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Chapter 19: Diseases of the Musculoskeletal System and Connective
Tissue
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Sample Questions
Q1) Personal history of arthritis
A)Z87.39
B)Z82.61
C)Z82.69
D)Z96.641
E)Z89.512
F)Z13.828
G)Z13.820
Q2) Patient with a family history of rheumatoid arthritis is being screened for rheumatoid arthritis.
A)Z13.820,Z82.69
B)Z13.89,Z82.62
C)Z13.828,Z82.61
D)Z13.828
Q3) Tennis elbow (right): __________
Q4) Internal derangement of left knee: __________
Q5) Ball joints are small stabilizing joints located between and behind adjacent vertebrae.
A)True
B)False
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Chapter 20: Diseases of the Genitourinary System
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Sample Questions
Q1) A patient is admitted to the hospital for further evaluation of stage 4 kidney disease.The patient is known to have been born with only one kidney,and on routine checkup it was found that the patient's kidney function was markedly abnormal.One year ago,the patient's laboratory tests were relatively normal.The patient's blood pressure was monitored,and it was decided that medications would be necessary to treat the patient's hypertension.The patient was advised about fluid intake and restriction and dietary considerations regarding protein and potassium.Referral was made to a nephrologist because the CKD appears to be progressing rapidly,and arrangements may be necessary for dialysis.Final Diagnosis: Chronic progressive renal failure,stage 4.Hypertension.
A)I12.9,N18.4,Q60.1
B)I12.0,N18.3,Q60.0
C)N18.5,I12.9,Q60.1
D)I12.9,N18.4,Q60.0
Q2) The main parts of the male genital or reproductive tract include the testes,epididymis,vas deferens,seminal vesicles,prostate,and penis.
A)True
B)False
Q3) Acute and chronic pyelonephritis due to Pseudomonas: __________
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Chapter 21: Pregnancy, Childbirth, and the Puerperium
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Sample Questions
Q1) What drug could be given to induce labor?
A)Stadol
B)Epidural
C)Pitocin
D)Terbutaline
Q2) What is an ectopic pregnancy?
Q3) The patient is admitted in labor at 38 weeks.She labors for 24 hours when it is noted that the baby is in fetal distress.The patient is taken to the OR for an emergency C-section (LTCS).She delivers a healthy baby.
A)O77.9,Z3A.38,Z37.0,10D00Z1
B)O77.8,Z3A.38,Z38.003
C)O77.8,Z3A.38,Z37.0,10D00Z1
D)O77.9,Z3A.38,Z38.00,10D00Z0
Q4) Early separation of placenta third trimester (38 weeks) delivered a single liveborn via vaginal delivery: __________
Q5) In referring to a pregnant woman,what does antepartum mean?
Q6) Missed abortion: __________
Q7) What does postpartum mean?
Q8) What does it mean when a pregnant woman is called primigravida?
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Chapter 22: Certain Conditions Originating in the Perinatal
Period and Congenital Malformations, deformations, and
Chromosomal Abnormalities
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Q1) A 53-year-old male with polycystic kidney disease is admitted.Laboratory tests reveal worsening kidney function,and the patient is classified at stage V chronic kidney disease.Workup for possible transplant is completed during admission,and the patient is placed on a transplant list.What codes are applicable? __________
Q2) What is a congenital anomaly?
Q3) Occurs in the fifth week of fetal development and is characterized by a small pouch on the wall of the small bowel containing ectopic tissue
A)Klinefelter's syndrome
B)Spina bifida
C)Meckel's diverticulum
D)Marfan syndrome
E)Tetralogy of Fallot
F)Down syndrome
Q4) In most cases,pregnancies with chromosomal anomalies end with a natural miscarriage.
A)True
B)False
Q5) Achondroplasia: __________
Q6) Cesarean delivery at term of baby with TTN: __________ Page 26
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Chapter 23: Injuries and Certain Other Consequences of
External Cases and External Causes of Morbidity
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Sample Questions
Q1) A patient is admitted with a parietal bone fracture and fracture of the left fifth rib.Assign only the injury code.
A)S02.0xxA,S22.31xA
B)S02.0xxA,S22.32xA
C)S22.32xA,S02.0xxA
D)S22.31xA,S02.0xxA
Q2) The patient sustained a contusion and severe sprain of left ankle after falling into a hole while hiking in the mountains while on vacation.
A)S93.401D,W17.2xxD,Y92.828
B)S93.401A,W17.2xxD,Y92.828,Y93.01,Y99.8
C)S93.402D,W17.2xxD,Y92.828,Y93.01,Y99.8
D)S93.402A,W17.2xxA,Y92.828,Y93.01,Y99.8
Q3) Fractured both wrists;left distal radius and ulna,right distal ulnar fracture,initial encounter: __________
Q4) A(n) ____________________ fracture causes injury to the surrounding tissues.
Q5) What is the main difficulty that coders have when trying to assign codes for final diagnoses?
Q6) Sprained left ankle,initial encounter: __________
Q7) A(n) ____________________ is a partial or completed dislocation.
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Chapter 24: Burns, adverse Effects, and Poisonings
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Sample Questions
Q1) Patient was admitted with second-degree burns of the left hand and first-degree burns of the left forearm.The patient touched a hot steam pipe.
A)T23.202A,T22.111A,X16.xxxA
B)T23.202A,T22.112A,X16.xxxA
C)T23.202D,T22.112D,X16.xxxD
D)T22.112A,T23.202A,X16.xxxA
Q2) Debridements must always be done in the OR.
A)True
B)False
Q3) The patient was admitted with hematemesis.The patient has been taking NSAIDs as directed by the physician for arthritis pain.EGD showed that the patient had an acute erosive gastritis,most likely due to NSAIDs,that is the likely cause of the bleeding.Final Diagnosis: Erosive gastritis with hemorrhage due to NSAIDs.Procedure: EGD with gastric biopsy.
A)K29.01,T39.395A,M19.90,0DB68ZX
B)T39.395A,K29.61,M19.90,0DB78ZZ
C)T49.0x2A,K29.00,M19.90,0DB78ZX
D)T49.0x1D,K29.71,M19.90,0DB67ZZ
Q4) Hives due to penicillin taken for strep throat: __________
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Chapter 25: Complications of Surgical and Medical Care
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Sample Questions
Q1) Patient was hospitalized 1 month prior to this admission.During that admit,she was diagnosed with COPD and placed on a ventilator;her sputum was positive for Pseudomonas aeruginosa.She is admitted today with another case of pneumonia.
A)J98.851,J18.9,J44.9
B)J18.9,J44.9
C)J95.851,486,B96.5
D)J44.9,J18.9,J95.851,B96.5
Q2) Patient has subclavian vein thrombosis due to PICC: __________
Q3) What does DVT stand for?
Q4) If the documentation is unclear whether the diagnosis was the result of a procedure or condition,a physician query should be initiated.
A)True
B)False
Q5) Displacement of an insulin pump,initial encounter;patient has type 1 DM:
Q6) Coding complications always imply that poor care has been delivered.
A)True B)False
Q7) How often are code Z94.0 and a T86.1- code used together?
Page 30
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Chapter 26: Reimbursement Methodologies
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43 Verified Questions
43 Flashcards
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Sample Questions
Q1) The United States Congress required CMS through the Balanced Budget Act of 1997 to begin applying a slightly different payment methodology when transferring patients from the acute care to the postacute care setting
A)Complication
B)Comorbidity
C)Quality Improvement Organization (QIO)
D)PEPPER-Program for Evaluating Payment Patterns Electronic Report
E)Postacute Transfer Policy
Q2) A patient with COPD is admitted to the hospital.Two days after admission,the COPD becomes exacerbated.The exacerbation of COPD should be designated as present on admission.
A)True
B)False
Q3) A(n) ____________________ is a preexisting condition (present on admission) of hospitalization.
Q4) Clinical documentation specialists would perform a concurrent review of a patient's health record for any missing or incomplete nursing documentation.
A)True
B)False
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Chapter 27: Out patient Coding
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42 Flashcards
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Sample Questions
Q1) Coding guidelines for uncertain diagnoses were developed for inpatient reporting and do not apply to outpatients.
A)True
B)False
Q2) When outpatient procedures are coded,codes from ____________________ are used.
Q3) Patient had a laparoscopic cholecystectomy for cholelithiasis (gallbladder) in the ambulatory surgery suite.In the recovery room,the patient is found to have atrial fibrillation,and the surgeon decides to admit the patient for observation: __________
Q4) What are APCs and what do they do?
Q5) Patient with right carpal tunnel syndrome had an endoscopic carpal tunnel release:
Q6) Chronic diseases treated on an ongoing basis can be coded only once,when the patient receives treatment and care for the condition.
A)True
B)False
Q7) When a patient comes to the hospital for outpatient surgery,what should a coder code as the first-listed diagnosis?
Q8) What are ancillary service visits?
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