WGU D366 PRACTICE EXAMINATION 2026
QUESTIONS WITH ANSWERS GRADED A+
◍ A billing and coding specialist is reviewing a partially paid claim that was
submitted without modifier 22 for increase procedural services. Which of
the following actions should the specialist take to obtain accurate
reimbursement? A) resubmit the claim with copies of the medical record
documentationB) submit an appeal with copies of the medical record
documentationC) contact the patient for additional reimbursementD) post
the payment and right off the difference.
Answer: B) submit an appeal with copies of the medical record
documentation
◍ J codes.
Answer: codes used for injectable drugs not able to be self administered
◍ Qualifiers or systems used for ROS: extended.
Answer: 2-9 systems: level 5
◍ Brief qualifiers:.
Answer: 1-3 qualifiers (level 2-3)
◍ A billing and coding specialist is completing a claim form for a Medicare
beneficiary for a wellness visit with her primary care provider who is a PAR
provider. Which of the following information is required on the form?A)
medicare identification number, date of birth, date of injuryB) Medicare
identification number, date of birth, and date of dischargeC) Medicare
identification number, date of birth, and referring physician's national
provider identifier (NPI) D) Medicare identification number, date of birth,
and accept assignment.
Answer: D) medicare identification number, date of birth, and accept
assignment
, ◍ to be reimbursed for any of the 10 E&M codes, you must document atleast:
(3).
Answer: one of the symptom descriptors: 7 variables HPIA ROS for at least
one pertinent body systemExamination-must document from a body system
◍ each documented "element" within a single organ system must be of a
______________________.
Answer: different method, such as inspecting vs palpation
◍ data review: 1 point for:.
Answer: lab test reviewed, radiology review, other diagnostic test, review of
test w/performing md, attempt to obtain outside records,review outside
records
◍ problem: 1 point given for.
Answer: self-limited/minor problem or established problem
(stable/improved)
◍ NP must decide what is medically necessary care for:.
Answer: the given diagnosis, and bill accordingly
◍ qualifiers or components of physical exam: detailed.
Answer: 12 elements in >/= 2 systems (level 4)
◍ After running a report, a billing and coding specialist discover several
claims are being denied for coding errors. To prevent future errors, which of
the following actions should the specialist take?A) educate the third-party
payer on researching coding issuesB) implement external audit processesC)
retrain staff on proper documentation and coding guidelinesD) right off the
claims that were incorrectly submitted.
Answer: C) retrain staff on proper documentation and coding guidelines
◍ Which of the following is a unique HIPAA-mandated number that is
required to submit a claim for surgical procedures, performed by a thoracic
surgeon?A) national provider identifier (NPI)B) employer identification
number (EIN) C) provider's Social Security number (SSN)D) diagnosis
QUESTIONS WITH ANSWERS GRADED A+
◍ A billing and coding specialist is reviewing a partially paid claim that was
submitted without modifier 22 for increase procedural services. Which of
the following actions should the specialist take to obtain accurate
reimbursement? A) resubmit the claim with copies of the medical record
documentationB) submit an appeal with copies of the medical record
documentationC) contact the patient for additional reimbursementD) post
the payment and right off the difference.
Answer: B) submit an appeal with copies of the medical record
documentation
◍ J codes.
Answer: codes used for injectable drugs not able to be self administered
◍ Qualifiers or systems used for ROS: extended.
Answer: 2-9 systems: level 5
◍ Brief qualifiers:.
Answer: 1-3 qualifiers (level 2-3)
◍ A billing and coding specialist is completing a claim form for a Medicare
beneficiary for a wellness visit with her primary care provider who is a PAR
provider. Which of the following information is required on the form?A)
medicare identification number, date of birth, date of injuryB) Medicare
identification number, date of birth, and date of dischargeC) Medicare
identification number, date of birth, and referring physician's national
provider identifier (NPI) D) Medicare identification number, date of birth,
and accept assignment.
Answer: D) medicare identification number, date of birth, and accept
assignment
, ◍ to be reimbursed for any of the 10 E&M codes, you must document atleast:
(3).
Answer: one of the symptom descriptors: 7 variables HPIA ROS for at least
one pertinent body systemExamination-must document from a body system
◍ each documented "element" within a single organ system must be of a
______________________.
Answer: different method, such as inspecting vs palpation
◍ data review: 1 point for:.
Answer: lab test reviewed, radiology review, other diagnostic test, review of
test w/performing md, attempt to obtain outside records,review outside
records
◍ problem: 1 point given for.
Answer: self-limited/minor problem or established problem
(stable/improved)
◍ NP must decide what is medically necessary care for:.
Answer: the given diagnosis, and bill accordingly
◍ qualifiers or components of physical exam: detailed.
Answer: 12 elements in >/= 2 systems (level 4)
◍ After running a report, a billing and coding specialist discover several
claims are being denied for coding errors. To prevent future errors, which of
the following actions should the specialist take?A) educate the third-party
payer on researching coding issuesB) implement external audit processesC)
retrain staff on proper documentation and coding guidelinesD) right off the
claims that were incorrectly submitted.
Answer: C) retrain staff on proper documentation and coding guidelines
◍ Which of the following is a unique HIPAA-mandated number that is
required to submit a claim for surgical procedures, performed by a thoracic
surgeon?A) national provider identifier (NPI)B) employer identification
number (EIN) C) provider's Social Security number (SSN)D) diagnosis
