NWCA Medical Billing and Coding Practice Exam

These questions are part of the practice quiz. Start practicing

• For a procedure with no specific CPT code in Category I or Category III, which coding option should be used?
• Which prenatal test is used to determine chromosomal abnormalities and biochemical disorders?
• In HIPAA transaction standards, which statements describe 837 and 835?
• What documentation is required when using an unlisted CPT code?
• What does CPT modifier 59 indicate?
• Unlisted CPT codes are used to report procedures when there is no specific CPT code in Category I or Category III.
• Which factors are included in anesthesia coding to reflect the overall case?
• What does unbundling mean in coding, and why is it discouraged?
• How are fractures coded for initial encounter vs subsequent encounter?
• In inpatient coding, how is the principal diagnosis defined?
• What is eligibility verification and why is it important?
• Which statement best describes the cortex in the brain?
• What is the purpose of ICD-10-CM official guidelines for coding and reporting?
• What items are included in the demographics section of a claim?
• When coding a coronary artery bypass graft, which fact must be reported?
• What two factors are considered when coding burns?
• Pediatric coding covers patients beyond which period?
• Which immune system component is produced by plasma cells and fights foreign invaders?
• Which of the following is not a type of psychotherapy?
• What best describes the relationship between CPT codes and HCPCS Level II codes?
• What does the 835 transaction represent in HIPAA standards?
• What is a 'denial' and what are common reasons for denials in medical billing?
• What is a modifier in CPT/HCPCS coding?
• In ICD-10-CM coding, why does acute vs chronic status matter?
• What is a sequela and how should it be coded?
• Which statement best describes Category III CPT codes?
• In ICD-10-CM coding, how is the current status conveyed?
• If outpatient claim and inpatient claim occur within 72 hours of each other and do not have the same diagnosis code, what should the provider do?
• Which statement about reporting multiple conditions in a hospital encounter is correct?
• How do you use modifiers 25 and 59 differently in a claim?
• What is the difference between the global surgical package and separate procedures?
• When coding multiple Anesthesia services for the same patient during the same encounter, which approach is correct?
• How should you determine the correct E/M code for an office visit under current guidelines?
• What is claim scrubbing and why is it used?
• What is batch claim submission and regulatory requirements?
• Which CPT code would represent Dr Mathew Bunker’s procedure on August 15 after rearranging the options?
• Which statement about NCCI edits is true?
• What is the difference between 'privacy' and 'security' under HIPAA?
• Which law prohibits physician referrals under certain financial relationships?
• When documentation includes a sequela, what should be coded?
• Which statement best describes a sentinel lymph node?
• What are HCPCS Level II codes used for?
• Which coding system is used to report diagnoses in U.S. medical billing?
• How do you prepare for audits?
• What are CPT codes used for?
• What is the primary purpose of coding audits in a medical practice?
• What method of coding has helped insurance companies provide fair reimbursement to providers?
• Which factor primarily supports time-based E/M coding for office visits when there is extensive counseling and coordination of care?
• Which statement best differentiates a claim denial from a denial reason?
• Which law prohibits physician referrals where there is a financial relationship that could influence referrals?
• In medical device terminology, which device is most similar to a pacemaker in function?
• Which statement is true about fracture encounters?
• In standard patient history documentation, which element is the second element?
• If the encounter is for diabetes management and the patient also has obesity, how should the diabetes with nephropathy and obesity be sequenced?
• In radiology CPT coding, which factor is listed to accompany modality and anatomic region?
• Basic guideline for vaccination administration coding and payer policy?
• If a service requires pre-authorization and it is not obtained, what is a likely consequence?
• Chorionic villus sampling is a prenatal test used to determine which of the following?
• What must a physician do to perform a tracheostomy?
• Which statement best describes medical necessity in the context of billing?
• What is an add-on CPT code and how is it reported?
• In CPT coding, what does the -50 modifier indicate when attached to a procedure code?
• What is medical necessity in coding and billing?
• If sepsis is documented with septic shock, how should it be coded?
• Which elements are typically required to support an E/M code?
• When are post-operative visits billable separately within the global period?
• What is the full description for CPT code 96402?
• What is upcoding and downcoding, and why are they problematic?
• Which form is used for professional services claims (physician, therapy, and other non-facility providers)?
• In ICD-10-CM coding, when a patient has an acute myocardial infarction and type 2 diabetes with nephropathy, which diagnosis should be listed first?
• Differentiate ICD-10-CM and ICD-10-PCS in terms of purpose.
• What is pre-authorization and when is it typically required?
• A patient has type 2 diabetes with nephropathy and obesity. How are these conditions coded and sequenced?
• Which CPT codes apply for Dr Bruce Prentice for dates of service August 12 through August 22?
• Which code set is used for inpatient hospital procedures?
• What is the NCCI and why is it important?
• How do you code for anesthesia services?
• The bone marrow or stem cell services/procedures category falls under which subheading?
• Which CPT code is used for a surgical pathology examination of a specimen?
• In CPT coding conventions, what does the plus sign before a code indicate?
• Medicare classifies surgeries as major, with a ___-day postoperative period.
• Which statement about vaccine administration coding is most accurate?
• A laparoscopic appendectomy falls under which CPT code category?
• What is medical coding integrity and how do audits work?
• When coding multiple anesthesia services during the same encounter, which approach is correct?
• Which statement best describes the UB-04 form's use?
• How is essential hypertension represented in ICD-10-CM coding principles?
• Explain the 'code first' concept with an example.
• Which CPT code would be appropriate for Dr Mathew Bunker on Date of Service August 15?
• A patient undergoes a laparoscopic appendectomy. Which CPT category and general code type applies?
• A sentinel lymph node is defined as which of the following?
• Under what circumstance might multiple obesity codes be required?
• Which statement about LCDs is true?
• In radiology, what is the term for the body position when the patient lies on the abdomen and the x-ray beam passes from the right side to the left?
• Which Medicare part covers inpatient hospital services?
• What is the medical term for repairing a kidney laceration?
• What documentation supports a CPT code for an ECG?
• Which sequence represents the typical steps in appealing a claim denial?
• Which term describes age-related loss of the ability to read small print?
• Which statement correctly describes the role of ionizing radiation in cancer treatment?
• What are 'NCDs' and 'LCDs'?
• A procedure in which the surgeon removes a slice of the cornea, reshapes it, and places it back onto the cornea is called:
• Under CMS reimbursement rules, which procedure or condition would the hospital not be reimbursed for?
• For CABG coding, which factor specifically drives the code selection?
• What is documentation improvement and how does it relate to coding accuracy?
• What is the concept of the global period in surgical coding?
• What is the general approach to coding preventive services such as adult physicals?
• In CPT coding, how should percutaneous coronary intervention (PCI) be coded?
• Which statement best describes the function of CDI teams?
• Which form is used for professional services claims (physician, therapy, and other non-facility providers)?
• What do NCCI edits do in relation to CPT components?
• How are HCPCS Level II codes used for durable medical equipment (DME)?
• Which procedure describes excision of a thyroid lobe along with part of the opposite lobe and the isthmus?
• To get up to 25 percent more for the procedure by using modifier -22, the physician must submit:
• What is the UB-04 form used for?
• Which description matches marsupialization in the context of pancreatic cyst treatment?
• Which coding system would you use to report non-physician services, supplies, equipment, and certain drugs not included in CPT?
• Which CPT code is used for a surgical pathology exam that includes gross and microscopic examination?
• Unlisted CPT codes are used to report procedures when there is no specific CPT code in which categories?
• Which statement about outpatient E/M level documentation is most accurate?
• Differentiate CPT and HCPCS Level II codes in terms of what they cover?
• How does CPT/E&M guidelines differentiate between a new patient and an established patient?
• When coding a burn, how should depth and surface area be used?
• In which situation is an unspecified ICD-10-CM code acceptable for a report?
• A patient receives ambulance transport services. Which coding system is used to report this service?
• What does 'code first' mean and when is it used?
• In relation to laboratory testing, what do glucose, lipoprotein, iron, and insulin have in common?
• Which component does CPT modifier 26 indicate in a service?
• A procedure to repair a kidney laceration after an injury from an object is called?
• A protein that plasma cells manufacture and that helps the body defend itself against foreign bodies is an)
• Which statement about payer guidelines is most accurate?
• How do out-of-network benefits typically impact patient costs?
• When an outpatient E/M code is billed with the -57 modifier, what does that signify?
• What is an 'allowable' amount?
• Why is ethical coding important in practice?
• In CPT coding, what does the -57 modifier indicate when attached to an evaluation and management code?
• Which option correctly identifies the use of unlisted codes for reporting procedures?
• What is the purpose of ICD-10-CM 'includes' and 'excludes' notes?
• Who publishes Coding Clinics?
• What is the term for when a patient receives care from two physicians on the same day for similar services?
• Which Medicare part would be billed for inpatient hospital services?
• What is bundling in CPT/NCCI and how does it affect coding?
• What are the key components of anesthesia coding?
• The serous membrane covering the testes is called the
• Which statement about UB-04 is true?
• What is time-based coding for E/M visits?
• What is the role of clinical documentation improvement (CDI) teams?
• Which statement is true about unlisted CPT codes?
• Which CPT code with modifier -26 would be used for a procedure performed on August 15 by Dr Kevin Rayburn?
• What is the difference between CPT modifier 25 and 59?
• To code a CABG, which detail is essential to determine the procedure code?
• When selecting an outpatient E/M level, which elements drive the level?
• When coding anesthesia service together with pain management, which statement is true?
• How is obesity coded in medical billing, and what considerations apply?
• On 8/17/yy, which CPT code would be appropriate for Dr. Kristen Conover?
• Give an example of documenting medical necessity for a test ordered by a clinician.
• What is the difference between in-network and out-of-network benefits?
• What is unbundling and why is it problematic compared to bundled codes?
• In ICD-10-CM, what is the difference between 'Excludes 1' and 'Excludes 2' notes?
• Which statement accurately describes when unlisted CPT codes are used?
• Failing to document medical necessity can lead to which outcome?
• For a claim from September 2013 that needs rebilling, which coding system should be used?
• Radiation oncology is a form of cancer treatment that uses which to shrink of kill malignant neoplasms
• Which component does CPT modifier TC indicate in a service?
• What is the difference between 'revenue cycle management' and 'claims processing'?
• Which code is used as the first-listed code in preventive care visits that include immunizations?
• How is radiology service coded in CPT?
• Which modifiers are used in the code entry 49505-50, 99213-57?
• How does abuse differ from fraud in medical billing?
• What must documentation demonstrate to support medical necessity?
• When a scheduled surgery is canceled, what is the first listed diagnosis?
• Which procedure uses a lighted flexible tube with an attached lens to view the inside of the respiratory system?
• If the global routine obstetric package is not completed by a single physician, how should billing be handled?
• What is the role of payer guidelines in coding and billing?
• How should length of stay be treated differently in inpatient versus outpatient coding?
• Cheiloplasty is the surgical repair of which structure?
• Which option is the first-line treatment for laryngeal cancer?
• CPT modifier 59 indicates which concept?
• What procedure includes the excision of an entire thyroid lobe, part of the opposite lobe and the isthmus?
• In ICD-10-CM coding, which codes capture non-disease encounters such as routine checkups or vaccinations?
• Which coding system was used for diagnoses on claims prior to ICD-10-CM, as in 2013?
• Newborn coding is distinguished from pediatric coding by focusing on which patient group?
• Which statement about hemoperfusion is true?
• Which item is NOT typically validated during data validation?
• Which statement accurately describes the relationship between a denial and its denial reason?
• Which statement best describes the effect of primary vs secondary diagnoses on billing?
• Pacemakers are most similar to which device?
• Statutory and regulatory compliance focuses on adherence to which laws?
• Which CPT code would represent Dr Christian Conover's initial hospital observation service on August 15?
• What is the highest possible Bishop score?
• Which form is used for facility claims (hospitals, inpatient/outpatient departments, and other facilities)?
• Which job duty pertains to a privacy officer?
• Which statement best distinguishes preventive care coding from problem-focused service coding?
• The full description for CPT code 68325 is
• In standard patient history documentation, which element typically follows the Chief Complaint?
• Which statement differentiates ICD-10-CM from ICD-10-PCS?
• When is an unlisted procedure code used?
• In Medicaid, what does EPSDT stand for?
• Which CPT code would be appropriate for Dr Christian Conover on Day of Service August 15?
• What is the medical term for age-related loss of near vision?
• What is the name for the gray matter in the brain that surrounds white matter in the brain?
• Which procedure is used to diagnose muscular dystrophy?
• Which source primarily determines the principal diagnosis in inpatient coding?
• Which statement best describes ICD-10-PCS codes?
• In a patient with chronic kidney disease and hypertensive heart disease, if the visit's main focus is kidney disease management, which code is typically listed first?
• What is the role of HIPAA transaction standards like 837 and 835?
• What is found before each subsection of the surgery section?
• When a patient is seen for preventive care and receives an immunization, which code is coded as the first-listed service?
• The tunica vaginalis is a serous membrane associated with which organ?
• Which term describes repairing a pancreatic cyst by incising it and suturing it open to drain?
• To code for a CABG, the coder must know the
• Which option best describes the typical demographics included on a claim?
• A patient with COPD develops acute respiratory failure in the hospital. Which coding approach applies?
• The HIPAA Privacy Rule is designed to protect what aspect of health information?
• For a patient with chronic kidney disease stage 3 and hypertensive heart disease, how should codes be sequenced when CKD drives the visit?
• For CABG coding, which detail best determines the code to report?
• Which procedure treats kidney stones with pulsating sound waves?
• Provide an example of an E/M code and what it represents.
• In ICD-10-CM coding, where is a chronic condition like essential hypertension typically documented?
• Hyperkeratotic lesions are coded by the:
• What is the purpose of NCCI edits in medical coding?
• What is the CMS-1500 form used for?
• What is the difference between a primary diagnosis and a secondary diagnosis?
• What best describes CPT Category I vs Category III codes?
• When is a vaccine administration code used in relation to a product code?
• Under what circumstances is an unspecified ICD-10-CM code acceptable?
• What is the impact of documentation accuracy on coding and reimbursement?
• How do you code for surgical procedures and the role of modifiers?
• Which action is least aligned with standard audit-preparedness practices?
• What is the purpose of keratomileusis?
• In inpatient hospital billing, which Medicare part is typically billed?
• What is 'data validation' in medical billing?
• The term for receiving care from two physicians on the same day for similar services is known as
• For a hospital encounter involving COPD and acute respiratory failure, which is the correct reporting approach?
• Which CPT code entry was used for Dr. Bruce Prentice on date of service 8/15/yy?
• How does telemedicine coding differ from in-person care coding?