AAPC CPC STUDY GUIDE 2025 QUESTIONS AND CORRECT ANSWERS

AAPC CPC STUDY GUIDE 2025
QUESTIONS AND CORRECT ANSWERS

CodingA2is:A2-A2Ans--
TheA2processA2ofA2translatingA2thisA2writtenA2orA2dictatedA2medicalA2recordA2intoA2aA2serie
sA2ofA2numericA2andA2alphaA2numericA2codes

ProperA2codeA2assignmentA2isA2determinedA2bothA2byA2-A2Ans--
theA2contentA2(documentation)A2inA2theA2medicalA2recordA2andA2byA2theA2uniqueA2rulesA2t
hatA2governA2eachA2codeA2setA2inA2thatA2particularA2instance

OutpatientA2codersA2willA2focusA2onA2learningA2whichA2manualsA2-A2Ans--
CPT,A2HCPCSA2LevelA2II,A2andA2ICD-10-CM

HospitalA2inpatientA2codersA2focusA2onA2whichA2manualsA2-A2Ans--ICD-10-CMA2&A2ICD-
10-PCS

RiskA2adjustmentA2codingA2focusesA2onA2whichA2manualA2-A2Ans--ICD-10-CMA2codeA2set

TwoA2primaryA2typesA2ofA2insurersA2-A2Ans--commercialA2andA2government

CommercialA2carriersA2areA2privateA2pairsA2thatA2mayA2offerA2groupA2andA2individualA2plan
s,A2plansA2veryA2butA2mayA2includeA2coverageA2forA2-A2Ans--
Hospitalization,A2basic,A2andA2majorA2medicalA2coverage

MedicareA2isA2-A2Ans--
TheA2mostA2significantA2governmentA2ensure,A2aA2federalA2healthA2insuranceA2program

MedicareA2isA2administeredA2byA2theA2centerA2forA2MedicareA2andA2MedicaidA2servicesA2(
CMS)-A2&A2providesA2coverageA2forA2whoA2-A2Ans--
PeopleA2overA2theA2ageA2ofA265,A2blindA2orA2disabled,A2individuals,A2andA2peopleA2withA2p
ermanentA2kidneyA2failureA2orA2endA2stageA2renalA2diseaseA2(ESRD).

MedicareA2partA2AA2coversA2-A2Ans--
InpatientA2hospital,A2skilledA2nursingA2facilities,A2hospice,A2andA2homeA2healthcare

MedicareA2partA2BA2coversA2-A2Ans--
Medically,A2necessary,A2physiciansA2services,A2outpatientA2care,A2andA2otherA2medicalA2s
ervicesA2(includingA2someA2preventativeA2services)A2notA2coveredA2underA2MedicareA2par
tA2a

MedicareA2partA2BA2isA2optionalA2whichA2pt.sA2payA2aA2-A2Ans--
premium,A2&A2generallyA2requiresA2aA2yearlyA2deductibleA2andA2coinsurance

, MedicareA2PartA2CA2(MedicareA2AdvantageA2Plans)A2-A2Ans--
CombinesA2MedicareA2partA2AA2partA2BA2andA2sometimesA2partA2D.A2ManagedA2byA2privat
eA2insuresA2approvedA2byA2Medicare.

MedicareA2partA2CA2plansA2mayA2chargeA2-A2Ans--
DifferentA2copayments,A2coinsurance,A2orA2deductiblesA2forA2services

MedicareA2partA2DA2isA2aA2-A2Ans--
PrescriptionA2drugA2programA2availableA2toA2allA2MedicareA2beneficiaries.A2PrivateA2comp
aniesA2approvedA2byA2MedicareA2provideA2coverage.

MedicaidA2isA2-A2Ans--
HealthA2insuranceA2assistanceA2forA2lowA2incomeA2people,A2(especiallyA2childrenA2andA2p
regnantA2women)

MedicaidA2isA2administeredA2onA2aA2-A2Ans--State-by-
stateA2basis,A2butA2stateA2programsA2mustA2hereA2toA2certainA2federalA2guidelines

TheA2feeA2scheduleA2designedA2toA2provideA2nationalA2uniformA2paymentA2ofA2MedicareA2
benefitsA2afterA2adjustmentA2toA2reflectA2theA2differencesA2inA2practiceA2costsA2acrossA2ge
ographicA2areasA2isA2calledA2theA2______________A2-A2Ans--
RBRVSA2(ResourceA2BasedA2RelativeA2ValueA2Scale)

ResourceA2basedA2relativeA2valueA2scaleA2costsA2areA2dividedA2intoA2threeA2componentsA
2-A2Ans--PhysiciansA2work,A2practiceA2expense,A2professionalA2liabilityA2insurance


PhysiciansA2workA2accountsA2forA2halfA2ofA2aA2procedures/
servicesA2totalA2relativeA2valueA2measuredA2byA2-A2Ans--
TheA2timeA2itA2takesA2toA2performA2service,A2technicalA2skill,A2andA2physicalA2effort,A2requi
redA2mentalA2effortA2andA2judgment,A2stressA2dueA2toA2potentialA2riskA2toA2theA2patient

PracticeA2expensesA2accountA2forA244%A2ofA2theA2totalA2relativeA2valueA2forA2eachA2servic
e,A2TheyA2areA2resourceA2basedA2andA2deferA2byA2siteA2ofA2serviceA2becauseA2-A2Ans--
TheA2expensiveA2providingA2aA2serviceA2inA2hospitalA2mayA2beA2differentA2thanA2physician
sA2office

TheA2resourceA2baseA2professionalA2liabilityA2insuranceA2(PLI)A2accountA2forA2-A2Ans--
4%A2ofA2theA2totalA2rallyA2relativeA2valueA2forA2eachA2service

PhysicianA2feeA2scheduleA2listsA2theA2componentA2valueA2forA2eachA2CPTA2andA2HCPCSA
2levelA2IIA2codeA2whichA2isA2publishedA2whenA2-A2Ans--AnnuallyA2byA2CMS


MedicalA2necessityA2meansA2-A2Ans--
WhetherA2procedureA2serviceA2isA2consideredA2appropriateA2inA2aA2givenA2circumstance