MEDICAL BILLING & CODING CERTIFICATION EXAM
PRACTICE QUESTIONS AND ANSWERS: THE MOST
RECENT AND COMPREHENSIVE VERSION WITH
VERIFIED ANSWERS; GUARANTEED PASS WITH
INSTANT PDF DOWNLOAD.
Exam Overview
This 150-question comprehensive assessment evaluates competency in all core domains of Medical
Billing & Coding, reflecting current professional standards and real-world practice. The exam includes
foundational theory, application-based scenarios, compliance, regulatory knowledge, reimbursement
methodologies, ethical decision-making, and critical reasoning.
Content Distribution:
Medical Terminology, Anatomy & Physiology – ~20 questions
ICD-10-CM Diagnosis Coding – ~35 questions
CPT & HCPCS Level II Coding – ~35 questions
Modifiers & Bundling – ~10 questions
Reimbursement Methodologies (CMS, DRG, APC, RBRVS) – ~15 questions
Insurance & Revenue Cycle Management – ~15 questions
Compliance, Fraud & Abuse Laws – ~10 questions
HIPAA, Documentation Standards & Ethics – ~10 questions
1. The term “bradycardia” refers to:
A. Rapid breathing
B. Irregular heartbeat
C. Slow heart rate
D. Enlarged heart
Rationale: “Brady-” means slow, and “-cardia” refers to heart rate.
2. The anatomical term “proximal” means:
A. Farther from the point of origin
B. Closer to the point of origin
C. Toward the back
D. Toward the midline
, Rationale: Proximal describes structures nearest the trunk or point of
origin.
3. ICD-10-CM codes are primarily used for:
A. Procedure reporting
B. Diagnosis reporting
C. Equipment billing only
D. Hospital reimbursement only
Rationale: ICD-10-CM codes classify diseases, conditions, and diagnoses.
4. A 45-year-old patient presents with Type 2 diabetes mellitus with diabetic
neuropathy. Which ICD-10-CM category applies?
A. E08
B. E09
C. E11
D. E13
Rationale: E11 is used for Type 2 diabetes mellitus.
5. The first-listed diagnosis in outpatient coding should reflect:
A. The most severe condition
B. The chief reason for the encounter
C. Chronic conditions only
D. The most expensive condition
Rationale: Outpatient guidelines require reporting the primary reason for
visit.
6. CPT codes are maintained by:
A. CMS
B. WHO
C. American Medical Association
, D. CDC
Rationale: The AMA publishes and maintains CPT coding.
7. HCPCS Level II codes primarily report:
A. Physician procedures
B. Diagnoses
C. Supplies, equipment, and certain services not in CPT
D. Inpatient facility charges
Rationale: HCPCS Level II includes alphanumeric codes for supplies and
DME.
8. Modifier -25 indicates:
A. Bilateral procedure
B. Significant, separately identifiable E/M service
C. Repeat procedure by another physician
D. Reduced service
Rationale: Modifier -25 is appended to E/M codes performed same day as
procedure.
9. A global surgical package includes:
A. Only intraoperative services
B. Preoperative, intraoperative, and postoperative services
C. Supplies only
D. Diagnostic testing only
Rationale: The global period bundles related surgical services.
10.The Resource-Based Relative Value Scale (RBRVS) determines:
A. Hospital DRGs
B. APC assignments
C. Physician reimbursement based on RVUs
, D. Patient deductibles
Rationale: RBRVS assigns relative value units to physician services.
11.Medicare Part B covers:
A. Inpatient hospital stays
B. Skilled nursing facility stays
C. Outpatient physician services
D. Hospice care only
Rationale: Part B covers outpatient and physician services.
12.The National Correct Coding Initiative (NCCI) was developed by:
A. AMA
B. Centers for Medicare & Medicaid Services
C. CDC
D. OIG
Rationale: CMS developed NCCI to prevent improper coding combinations.
13.A claim denied due to “lack of medical necessity” indicates:
A. Incorrect patient demographics
B. Duplicate claim
C. Diagnosis does not support procedure
D. Missing modifier
Rationale: Payers require documentation proving necessity.
14.HIPAA was enacted in:
A. 1986
B. 1990
C. 1996
D. 2001
Rationale: HIPAA became law in 1996.
PRACTICE QUESTIONS AND ANSWERS: THE MOST
RECENT AND COMPREHENSIVE VERSION WITH
VERIFIED ANSWERS; GUARANTEED PASS WITH
INSTANT PDF DOWNLOAD.
Exam Overview
This 150-question comprehensive assessment evaluates competency in all core domains of Medical
Billing & Coding, reflecting current professional standards and real-world practice. The exam includes
foundational theory, application-based scenarios, compliance, regulatory knowledge, reimbursement
methodologies, ethical decision-making, and critical reasoning.
Content Distribution:
Medical Terminology, Anatomy & Physiology – ~20 questions
ICD-10-CM Diagnosis Coding – ~35 questions
CPT & HCPCS Level II Coding – ~35 questions
Modifiers & Bundling – ~10 questions
Reimbursement Methodologies (CMS, DRG, APC, RBRVS) – ~15 questions
Insurance & Revenue Cycle Management – ~15 questions
Compliance, Fraud & Abuse Laws – ~10 questions
HIPAA, Documentation Standards & Ethics – ~10 questions
1. The term “bradycardia” refers to:
A. Rapid breathing
B. Irregular heartbeat
C. Slow heart rate
D. Enlarged heart
Rationale: “Brady-” means slow, and “-cardia” refers to heart rate.
2. The anatomical term “proximal” means:
A. Farther from the point of origin
B. Closer to the point of origin
C. Toward the back
D. Toward the midline
, Rationale: Proximal describes structures nearest the trunk or point of
origin.
3. ICD-10-CM codes are primarily used for:
A. Procedure reporting
B. Diagnosis reporting
C. Equipment billing only
D. Hospital reimbursement only
Rationale: ICD-10-CM codes classify diseases, conditions, and diagnoses.
4. A 45-year-old patient presents with Type 2 diabetes mellitus with diabetic
neuropathy. Which ICD-10-CM category applies?
A. E08
B. E09
C. E11
D. E13
Rationale: E11 is used for Type 2 diabetes mellitus.
5. The first-listed diagnosis in outpatient coding should reflect:
A. The most severe condition
B. The chief reason for the encounter
C. Chronic conditions only
D. The most expensive condition
Rationale: Outpatient guidelines require reporting the primary reason for
visit.
6. CPT codes are maintained by:
A. CMS
B. WHO
C. American Medical Association
, D. CDC
Rationale: The AMA publishes and maintains CPT coding.
7. HCPCS Level II codes primarily report:
A. Physician procedures
B. Diagnoses
C. Supplies, equipment, and certain services not in CPT
D. Inpatient facility charges
Rationale: HCPCS Level II includes alphanumeric codes for supplies and
DME.
8. Modifier -25 indicates:
A. Bilateral procedure
B. Significant, separately identifiable E/M service
C. Repeat procedure by another physician
D. Reduced service
Rationale: Modifier -25 is appended to E/M codes performed same day as
procedure.
9. A global surgical package includes:
A. Only intraoperative services
B. Preoperative, intraoperative, and postoperative services
C. Supplies only
D. Diagnostic testing only
Rationale: The global period bundles related surgical services.
10.The Resource-Based Relative Value Scale (RBRVS) determines:
A. Hospital DRGs
B. APC assignments
C. Physician reimbursement based on RVUs
, D. Patient deductibles
Rationale: RBRVS assigns relative value units to physician services.
11.Medicare Part B covers:
A. Inpatient hospital stays
B. Skilled nursing facility stays
C. Outpatient physician services
D. Hospice care only
Rationale: Part B covers outpatient and physician services.
12.The National Correct Coding Initiative (NCCI) was developed by:
A. AMA
B. Centers for Medicare & Medicaid Services
C. CDC
D. OIG
Rationale: CMS developed NCCI to prevent improper coding combinations.
13.A claim denied due to “lack of medical necessity” indicates:
A. Incorrect patient demographics
B. Duplicate claim
C. Diagnosis does not support procedure
D. Missing modifier
Rationale: Payers require documentation proving necessity.
14.HIPAA was enacted in:
A. 1986
B. 1990
C. 1996
D. 2001
Rationale: HIPAA became law in 1996.
