AHIMA Certified Coding Specialist – Physician-based (CCS-P) Practice Exam

These questions are part of the practice quiz. Start practicing

• Which of the following is considered psychotherapy notes?
• What does reliability refer to in the context of data?
• What percentage of the PAR Medicare allowed amount does a NON PAR provider receive?
• What is the primary advantage of using electronic health records (EHRs) for coding?
• What payment does a negotiated fee schedule mandate?
• What does "hard coding" refer to?
• What is Retrovir prescribed to treat?
• In the claims appeal process, what is the significance of making a request within 120 days?
• What must practices ensure when establishing fee schedules?
• What are discounted charges in a medical billing context?
• Why is it critical for a practice to assess codes that provide the majority of its revenue?
• What does the term “primary diagnosis” mean in coding?
• What does a disease index do?
• When should abnormal laboratory findings be coded?
• What is defined as an adverse effect in medication?
• Who are qui tam plaintiffs?
• What is a key factor in determining the level of service for E/M coding?
• What does the ICD-10 code “E11.9” represent?
• What is the role of the National Correct Coding Initiative (NCCI)?
• What does it mean when a health plan is described as “capitated”?
• Why is it essential to review coding guidelines regularly?
• What is a Superbill commonly referred to as?
• What are benefits of using email in healthcare?
• What information does a progress note contain regarding patient treatment?
• In the context of risk adjustment, what does “hierarchical condition category” (HCC) mean?
• What does the abbreviation “RBRVS” refer to in the context of payment models?
• What commonly affects the quality of documentation in healthcare coding?
• What role do parenthetical notes play for coders?
• What is a common complication associated with labor and delivery?
• What does the term “medical necessity” imply in healthcare billing?
• The Usual Customary Fee profile is based on what?
• How often should fee evaluations occur if the practice relies on negotiated rates?
• Which of the following is NOT classified as a common viral disease?
• Which of the following best describes the relationship between medical coding compliance and accurate billing?
• What is the difference between “Allergy” and “Intolerance” in medical coding?
• What is the time limit to request a claim appeal after receiving the initial claim determination?
• Which of the following best describes “Initial Plan” in a POMR?
• What does the term “carve-out” mean in relation to healthcare services?
• What are “unlisted procedure codes” in CPT coding?
• What is the significance of “clinical documentation improvement” (CDI) in coding?
• Which of the following is a key element of coding guidelines?
• During the claims redetermination process, who reviews the claims?
• What is the purpose of updating the office encounter form yearly?
• What modifier would be used to indicate a service was provided more than once by the same provider?
• Psychotherapy codes are primarily assigned based on which of the following criteria?
• Which organization maintains the diagnosis classifications in volumes 1 and 2 of ICD-9?
• What does 'aseptic meningitis' refer to in the context of common viral diseases?
• In what situation would you use an “add-on code”?
• Why is the claims appeal process essential for health care providers?
• What is required for accurate coding based on laboratory findings?
• When does CMS send the payment directly to the patient?
• What is a common bacterial disease caused by Streptococcus pneumoniae?
• What is the primary benefit of utilizing parenthetical notes in medical coding?
• Which document summarizes the episode of care and current status of a patient?
• Which of the following is a critical aspect of claims redetermination?
• What essential aspect should healthcare providers focus on to ensure coding compliance?
• Which of the following best describes the relationship between coding and revenue production?
• What are negotiations for a fee schedule based on?
• Which of the following is NOT a risk area identified by the OIG?
• In coding guidelines, how should late effects be sequenced?
• What is the first step in the claims appeal process?
• What information cannot be shared as part of the 'anticipation' clause under HIPAA?
• What is considered a contributing component in CPT coding?
• What key component is NOT part of CPT coding?
• What does granularity in data quality refer to?
• What does a “code freeze” in ICD coding updates signify?
• What information is cross-referenced in a master patient index?
• What could be a consequence of non-compliance in medical coding?
• Which report is considered best for determining the size of a removed malignant lesion?
• Why is adherence to legal requirements important in medical coding?
• What is the practice of clustering in medical coding?
• What does a charge summary contain?
• What does validity refer to in the context of data?
• How is a Problem Oriented Medical Record (POMR) primarily organized?
• How can you ensure compliance with payer policies during the coding process?
• What is the main function of the “audit process” in coding?
• How often are ICD-9-CM diagnosis and procedure codes issued according to the Medicare Prescription Drug, Improvement and Modernization Act of 2003?
• What is required for patients covered by Medicare when reporting Initial Hospital Service codes?
• In CPT coding, what is the significance of the documentation provided?
• Which of the following is a common bacterial cause of meningitis?
• In CPT coding, what is the significance of the information provided in parenthetical notes?
• What does the term "limiting charge" refer to in relation to Medicare providers?
• What is a primary use of spreadsheet software in medical office management?
• In which situation can code 99291 (E/M critical care) be used instead of a medical visit or ER code?
• What does a revenue production report show?
• What does the term “bundled payment” mean in healthcare?
• Which of the following best defines medical coding compliance?
• What must be documented according to E/M service guidelines?
• What is the definition of Computer Assisted Coding (CAC) according to AHIMA?
• What defines Point of Care Service in medical documentation?
• What condition is characterized by an abnormal opening in the ventricular septum?
• Which of the following is NOT a key aspect of medical decision-making in CPT coding?
• Where can payor specific guidelines typically be found?
• Which type of information is NOT allowed to be shared with patients according to HIPAA?
• What is Protonix primarily used to treat?
• What does RBRVS stand for?
• Which of the following is NOT a common viral disease?
• What does it mean when a claim is “denied”?
• What does ABN stand for in the context of Medicare procedures?
• What does “downcoding” refer to in medical billing?
• What is an effective method to select an audit sample?
• Which of the following is NOT a component of Data Quality Analysis?
• Which section of the CPT manual would you refer to for surgical procedures?
• What should a manager do following a coding audit?
• What do parenthetical notes in CPT coding provide?
• What does an operation index predominantly list?
• What is the primary goal of medical coding compliance?
• What is documented in the Progress Note of a POMR?
• What are the codes in the range of 99201-99205 used for?
• What is one outcome of maintaining coding compliance within a practice?
• In the context of patient billing, what does the chargemaster typically include?
• What is the appropriate ICD-9-CM diagnosis code for contraceptive sterilization?
• How does coding affect the healthcare revenue cycle?
• What does clinical data pertain to in a healthcare setting?
• What section of a POMR serves as a “Table of Contents”?
• What is a “superbill”?
• What does Stark Law aim to prevent regarding healthcare referrals?
• Which organization works alongside AHIMA to provide advice on coding guidelines for ICD-9?
• What do ICD-10 codes primarily describe?
• What is documented in an “audit trail” within EHR systems?
• What is the purpose of Depro-Provera?
• What are the components measured by AMA medical decision making?
• What does the abbreviation “CPT” stand for?
• What mental health condition is Haldol commonly prescribed for?
• Which organism is associated with gonorrhea?
• What characteristics define Klebsiella in a clinical context?
• What does the term “unbundling” refer to in coding?
• What does the 'minimum necessary' standard govern according to HIPAA?
• What is the purpose of an ABN?
• Which of the following contributes to fraudulent billing practices?
• How do you define “risk adjustment” in coding?
• Why is the correct assignment of diagnosis codes crucial in healthcare?
• What is a primary source for obtaining answers to questions regarding coding policies?
• Which coding system is primarily used for reporting ambulatory surgical procedures?
• Which of the following would be considered a violation of Stark Law?
• What is the purpose of CPT coding in the healthcare setting?
• What is a “modifier” in medical coding?
• What is a primary objective of conducting a claims redetermination?
• What does the PDR stand for in medical coding?
• In which section of the CPT manual would you find guidelines for consultation codes?
• What role does email play in patient care communication?
• In the context of medical coding, what does “global period” refer to?
• What is a primary barrier to the widespread use of automated code assignments?
• What is the primary focus of the minimum necessary standard in HIPAA?
• Which law prohibits physicians from referring patients to entities in which they have a financial relationship for services covered by federal or state health benefits programs?
• What does “modification” in coding generally involve?
• What condition must be met for a physician to make a referral under Stark Law?
• What is the purpose of the Coding Clinic?
• What defines an adverse effect of a medication?
• In E/M coding, what does the term “history” refer to?
• When is it appropriate for coders to assign codes from lab reports alone?
• What is one potential consequence for a physician who violates Stark Law?
• Which condition is specifically treated by potassium replacement therapy?
• What role does accuracy play in the context of claim submissions?
• Which modifier is used to indicate a procedure was performed on the left side of the body?
• What is a database in a medical coding context?
• What is the primary focus of physician-based coding?
• When can radiology reports be utilized for coding purposes?
• What is the significance of the term “place of service” in medical billing?
• What must be included with a claim when using an unlisted CPT code?
• Which statement about coding guidelines is true?
• Which statement is true regarding insurance payments?
• If a procedure code has multiple indicators, what action should be taken?
• What is the purpose of coding edits in the claims process?
• What causes aspiration pneumonia?
• How does HIPAA law relate to children under 18?
• What does the CPT Assistant provide guidance on?
• Which of the following describes unbundling in medical billing?
• What is a feature of Excel that benefits data management in medical coding?
• When should unlisted codes in CPT be used?
• What is the primary purpose of a fee schedule in a medical practice?
• What is the purpose of a physician index?
• What does the abbreviation “CMS” stand for in healthcare?
• What type of guidelines do Local and National Coverage Determinations provide?
• Which statement best defines "documenting time" in E/M services?
• Which information must be verified for coding purposes?
• What is defined as late pregnancy in terms of gestational weeks?
• Which of the following is not a documented complication from labor and delivery?
• What does the CMS guidance require for coding in critical care situations?
• What is a negotiated fee schedule primarily established between?
• What is a “diagnosis-related group” (DRG)?
• Which organism is commonly known for causing tuberculosis?
• How is a “new patient” defined in the context of E/M coding?
• How often is the Coding Clinic published?
• What term describes a woman who is giving birth to her first child after the age of 35?
• What does effective medical coding compliance help to prevent?
• What action should an office manager take if unbundling practices are discovered?
• What is the function of the HCPCS Level II codes?
• What is a “claim scrubber”?
• How often are CPT codes updated?
• What is the function of an encoder in a physician's office?
• What does HCPCS Modifier A1 indicate?
• What is a standard aspect of health insurance concerning patient costs?
• Which of the following is defined as the newborn period?