Medical Coding (CPC) – ICD-10, CPT & Billing Systems Practice Exam Updated 2026
🩺 | Complete Study Guide with Verified Questions and Detailed Rationales
Covering ICD-10-CM Diagnosis Coding Guidelines, CPT Procedure Coding and
Modifiers, HCPCS Level II Codes, Medical Billing Processes and Revenue Cycle
Management, Insurance Claims Submission (CMS-1500), Compliance and
Documentation Standards, Coding Audits and Error Prevention, Reimbursement
Methodologies, and Scenario-Based Questions for CPC Certification Exam Success
Question 1: Which ICD-10-CM code category is used to report a patient's history of
malignant neoplasm when the cancer has been eradicated and the patient is no
longer receiving treatment?
A. C00-C96
B. Z85.-
C. Z86.010
D. Z12.11
CORRECT ANSWER: B. Z85.-
EXPLANATION:ICD-10-CM category Z85 is used to report personal history of malignant
neoplasm. This category is appropriate when the primary cancer has been excised or
eradicated, there is no further treatment directed to that site, and there is no evidence
of any existing primary malignancy. Codes from C00-C96 are for current malignancies,
Z86.010 is for personal history of colonic polyps, and Z12.11 is for screening for
malignant neoplasm of colon.
Question 2: When coding an excision of a malignant lesion of the skin, which CPT
code range should be referenced first?
A. 11400-11446
B. 11600-11646
C. 17000-17004
D. 17260-17286
CORRECT ANSWER: B. 11600-11646
EXPLANATION:CPT codes 11600-11646 are specifically designated for excision of
malignant lesions of the skin, including margins, and are selected based on lesion
diameter and anatomical location. Codes 11400-11446 are for benign lesion excisions,
17000-17004 are for destruction of premalignant lesions, and 17260-17286 are for
destruction of malignant lesions by methods other than excision.
Question 3: Which modifier indicates that a procedure or service was distinct or
independent from other services performed on the same day?
A. -25
B. -59
C. -51
D. -76
,CORRECT ANSWER: B. -59
EXPLANATION:Modifier -59 is used to identify procedures/services that are not
normally reported together but are appropriate under the circumstances. It indicates
that a procedure is distinct or independent from other services performed on the same
day. Modifier -25 is for significant, separately identifiable E/M service, -51 is for multiple
procedures, and -76 is for repeat procedure by same physician.
Question 4: In ICD-10-CM, what does the 7th character "A" typically represent in
injury codes?
A. Subsequent encounter
B. Sequela
C. Initial encounter
D. Unspecified encounter
CORRECT ANSWER: C. Initial encounter
EXPLANATION:In ICD-10-CM injury codes (Chapter 19), the 7th character "A"
designates an initial encounter, which is used for each encounter where the patient is
receiving active treatment for the injury. "D" represents subsequent encounter for
routine healing, and "S" represents sequela for complications or conditions arising as a
direct result of an injury.
Question 5: Which HCPCS Level II code would be appropriate for reporting a
standard wheelchair with fixed arms and swing-away footrests?
A. E1161
B. K0001
C. K0005
D. E1235
CORRECT ANSWER: B. K0001
EXPLANATION:HCPCS code K0001 describes a standard wheelchair with fixed arms
and swing-away footrests, which is the most basic manually operated wheelchair.
E1161 is for a heavy-duty wheelchair, K0005 is for an ultra-lightweight wheelchair, and
E1235 is for a wheelchair with detachable arms.
Question 6: When reporting an Evaluation and Management (E/M) service, which
key component is NOT required for established patient office visits?
A. History
B. Examination
C. Medical Decision Making
D. Counseling
CORRECT ANSWER: D. Counseling
, EXPLANATION:For established patient office visits (CPT 99211-99215), the three key
components are history, examination, and medical decision making. Counseling is a
contributing factor but not a required key component for code selection. Time may be
used as the controlling factor when counseling and/or coordination of care dominates
the encounter.
Question 7: Which ICD-10-CM code should be reported for a patient diagnosed with
type 2 diabetes mellitus with diabetic neuropathy?
A. E11.40
B. E11.42
C. E10.42
D. E13.42
CORRECT ANSWER: B. E11.42
EXPLANATION:ICD-10-CM code E11.42 specifically represents type 2 diabetes mellitus
with diabetic polyneuropathy. E11.40 is type 2 diabetes with diabetic neuropathy,
unspecified, E10.42 is for type 1 diabetes with diabetic polyneuropathy, and E13.42 is
for other specified diabetes mellitus with diabetic polyneuropathy.
Question 8: What is the primary purpose of the National Correct Coding Initiative
(NCCI)?
A. To establish reimbursement rates for Medicare services
B. To prevent improper payment when certain services are reported together
C. To provide coding education for new medical coders
D. To determine medical necessity for surgical procedures
CORRECT ANSWER: B. To prevent improper payment when certain services are
reported together
EXPLANATION:The National Correct Coding Initiative (NCCI) was developed by CMS to
promote national correct coding methodologies and to control improper coding leading
to inappropriate payment. NCCI edits identify pairs of services that should not be
reported together because they are either mutually exclusive or one is a component of
the other.
Question 9: Which CPT code should be reported for a simple repair of a 2.5 cm
superficial wound of the scalp?
A. 12001
B. 12011
C. 12031
D. 12051
CORRECT ANSWER: B. 12011
EXPLANATION:CPT code 12011 describes simple repair of superficial wounds of scalp,
arms, and/or legs; 2.6 cm to 7.5 cm. However, for a 2.5 cm wound, code 12001 (simple
, repair of superficial wounds of scalp, arms, and/or legs; 2.5 cm or less) would be
correct. Correction: For a 2.5 cm superficial scalp wound, 12001 is correct. Let me
recalculate: 12001 is for 2.5 cm or less on scalp/arms/legs. Therefore, the correct
answer should be A. 12001. Let me fix this.
CORRECT ANSWER: A. 12001
EXPLANATION:CPT code 12001 describes simple repair of superficial wounds of the
scalp, arms, and/or legs that are 2.5 cm or less in length. Since the wound is superficial,
located on the scalp, and measures exactly 2.5 cm, code 12001 is the appropriate
selection. Code 12011 is for wounds 2.6-7.5 cm, 12031 is for intermediate repair, and
12051 is for complex repair.
Question 10: Which anatomical plane divides the body into anterior and posterior
sections?
A. Sagittal plane
B. Transverse plane
C. Frontal (coronal) plane
D. Oblique plane
CORRECT ANSWER: C. Frontal (coronal) plane
EXPLANATION:The frontal (coronal) plane divides the body into anterior (front) and
posterior (back) sections. The sagittal plane divides the body into right and left sections,
the transverse plane divides the body into superior and inferior sections, and the
oblique plane is an angled cut not aligned with the standard anatomical planes.
Question 11: When coding a bilateral procedure that has a unilateral CPT code,
which modifier should be appended?
A. -50
B. -LT and -RT
C. -52
D. -73
CORRECT ANSWER: A. -50
EXPLANATION:Modifier -50 is used to identify bilateral procedures that are performed
during the same operative session. While some payers accept -LT and -RT to indicate
left and right sides separately, modifier -50 is the standard CPT modifier for bilateral
procedures when a single code describes the unilateral service.
Question 12: Which ICD-10-CM code represents acute appendicitis with
generalized peritonitis?
A. K35.2
B. K35.3
C. K35.80
D. K36
🩺 | Complete Study Guide with Verified Questions and Detailed Rationales
Covering ICD-10-CM Diagnosis Coding Guidelines, CPT Procedure Coding and
Modifiers, HCPCS Level II Codes, Medical Billing Processes and Revenue Cycle
Management, Insurance Claims Submission (CMS-1500), Compliance and
Documentation Standards, Coding Audits and Error Prevention, Reimbursement
Methodologies, and Scenario-Based Questions for CPC Certification Exam Success
Question 1: Which ICD-10-CM code category is used to report a patient's history of
malignant neoplasm when the cancer has been eradicated and the patient is no
longer receiving treatment?
A. C00-C96
B. Z85.-
C. Z86.010
D. Z12.11
CORRECT ANSWER: B. Z85.-
EXPLANATION:ICD-10-CM category Z85 is used to report personal history of malignant
neoplasm. This category is appropriate when the primary cancer has been excised or
eradicated, there is no further treatment directed to that site, and there is no evidence
of any existing primary malignancy. Codes from C00-C96 are for current malignancies,
Z86.010 is for personal history of colonic polyps, and Z12.11 is for screening for
malignant neoplasm of colon.
Question 2: When coding an excision of a malignant lesion of the skin, which CPT
code range should be referenced first?
A. 11400-11446
B. 11600-11646
C. 17000-17004
D. 17260-17286
CORRECT ANSWER: B. 11600-11646
EXPLANATION:CPT codes 11600-11646 are specifically designated for excision of
malignant lesions of the skin, including margins, and are selected based on lesion
diameter and anatomical location. Codes 11400-11446 are for benign lesion excisions,
17000-17004 are for destruction of premalignant lesions, and 17260-17286 are for
destruction of malignant lesions by methods other than excision.
Question 3: Which modifier indicates that a procedure or service was distinct or
independent from other services performed on the same day?
A. -25
B. -59
C. -51
D. -76
,CORRECT ANSWER: B. -59
EXPLANATION:Modifier -59 is used to identify procedures/services that are not
normally reported together but are appropriate under the circumstances. It indicates
that a procedure is distinct or independent from other services performed on the same
day. Modifier -25 is for significant, separately identifiable E/M service, -51 is for multiple
procedures, and -76 is for repeat procedure by same physician.
Question 4: In ICD-10-CM, what does the 7th character "A" typically represent in
injury codes?
A. Subsequent encounter
B. Sequela
C. Initial encounter
D. Unspecified encounter
CORRECT ANSWER: C. Initial encounter
EXPLANATION:In ICD-10-CM injury codes (Chapter 19), the 7th character "A"
designates an initial encounter, which is used for each encounter where the patient is
receiving active treatment for the injury. "D" represents subsequent encounter for
routine healing, and "S" represents sequela for complications or conditions arising as a
direct result of an injury.
Question 5: Which HCPCS Level II code would be appropriate for reporting a
standard wheelchair with fixed arms and swing-away footrests?
A. E1161
B. K0001
C. K0005
D. E1235
CORRECT ANSWER: B. K0001
EXPLANATION:HCPCS code K0001 describes a standard wheelchair with fixed arms
and swing-away footrests, which is the most basic manually operated wheelchair.
E1161 is for a heavy-duty wheelchair, K0005 is for an ultra-lightweight wheelchair, and
E1235 is for a wheelchair with detachable arms.
Question 6: When reporting an Evaluation and Management (E/M) service, which
key component is NOT required for established patient office visits?
A. History
B. Examination
C. Medical Decision Making
D. Counseling
CORRECT ANSWER: D. Counseling
, EXPLANATION:For established patient office visits (CPT 99211-99215), the three key
components are history, examination, and medical decision making. Counseling is a
contributing factor but not a required key component for code selection. Time may be
used as the controlling factor when counseling and/or coordination of care dominates
the encounter.
Question 7: Which ICD-10-CM code should be reported for a patient diagnosed with
type 2 diabetes mellitus with diabetic neuropathy?
A. E11.40
B. E11.42
C. E10.42
D. E13.42
CORRECT ANSWER: B. E11.42
EXPLANATION:ICD-10-CM code E11.42 specifically represents type 2 diabetes mellitus
with diabetic polyneuropathy. E11.40 is type 2 diabetes with diabetic neuropathy,
unspecified, E10.42 is for type 1 diabetes with diabetic polyneuropathy, and E13.42 is
for other specified diabetes mellitus with diabetic polyneuropathy.
Question 8: What is the primary purpose of the National Correct Coding Initiative
(NCCI)?
A. To establish reimbursement rates for Medicare services
B. To prevent improper payment when certain services are reported together
C. To provide coding education for new medical coders
D. To determine medical necessity for surgical procedures
CORRECT ANSWER: B. To prevent improper payment when certain services are
reported together
EXPLANATION:The National Correct Coding Initiative (NCCI) was developed by CMS to
promote national correct coding methodologies and to control improper coding leading
to inappropriate payment. NCCI edits identify pairs of services that should not be
reported together because they are either mutually exclusive or one is a component of
the other.
Question 9: Which CPT code should be reported for a simple repair of a 2.5 cm
superficial wound of the scalp?
A. 12001
B. 12011
C. 12031
D. 12051
CORRECT ANSWER: B. 12011
EXPLANATION:CPT code 12011 describes simple repair of superficial wounds of scalp,
arms, and/or legs; 2.6 cm to 7.5 cm. However, for a 2.5 cm wound, code 12001 (simple
, repair of superficial wounds of scalp, arms, and/or legs; 2.5 cm or less) would be
correct. Correction: For a 2.5 cm superficial scalp wound, 12001 is correct. Let me
recalculate: 12001 is for 2.5 cm or less on scalp/arms/legs. Therefore, the correct
answer should be A. 12001. Let me fix this.
CORRECT ANSWER: A. 12001
EXPLANATION:CPT code 12001 describes simple repair of superficial wounds of the
scalp, arms, and/or legs that are 2.5 cm or less in length. Since the wound is superficial,
located on the scalp, and measures exactly 2.5 cm, code 12001 is the appropriate
selection. Code 12011 is for wounds 2.6-7.5 cm, 12031 is for intermediate repair, and
12051 is for complex repair.
Question 10: Which anatomical plane divides the body into anterior and posterior
sections?
A. Sagittal plane
B. Transverse plane
C. Frontal (coronal) plane
D. Oblique plane
CORRECT ANSWER: C. Frontal (coronal) plane
EXPLANATION:The frontal (coronal) plane divides the body into anterior (front) and
posterior (back) sections. The sagittal plane divides the body into right and left sections,
the transverse plane divides the body into superior and inferior sections, and the
oblique plane is an angled cut not aligned with the standard anatomical planes.
Question 11: When coding a bilateral procedure that has a unilateral CPT code,
which modifier should be appended?
A. -50
B. -LT and -RT
C. -52
D. -73
CORRECT ANSWER: A. -50
EXPLANATION:Modifier -50 is used to identify bilateral procedures that are performed
during the same operative session. While some payers accept -LT and -RT to indicate
left and right sides separately, modifier -50 is the standard CPT modifier for bilateral
procedures when a single code describes the unilateral service.
Question 12: Which ICD-10-CM code represents acute appendicitis with
generalized peritonitis?
A. K35.2
B. K35.3
C. K35.80
D. K36
