ICD-10-CM/PCS & HIM Exam Prep
2026/2027: 80 Multiple-Choice Questions
with Answers & Explanations | HIPAA,
CDI, Medical Necessity, Coding Guidelines
Description:
Master medical coding for 2026/2027 with 80 realistic exam questions covering ICD-10-
CM, ICD-10-PCS, CPT, HCPCS, CDI, SOAP notes, and HIPAA compliance.
Each answer includes a detailed explanation. Perfect for RHIT, CPC, CCS, and CIC
candidates.
Download the full 2026/2027 practice exam now and pass with confidence!
, Medical Coding Exam 2026/2027: 80 Q&A
Section 1: Healthcare Regulatory and Administrative Frameworks
Question 1
The Centers for Medicare & Medicaid Services (CMS) functions as a(n) __________ within
the federal Department of Health and Human Services (DHHS).
A. private organization
B. administrative agency
C. third-party payer
D. compliance section
Answer: B. administrative agency
Explanation: CMS is a federal administrative agency operating under DHHS. It oversees
Medicare, Medicaid, and other health insurance programs, making it a governmental
regulatory and administrative body rather than a private entity or purely financial
intermediary.
Question 2
Which federal legislation requires all code sets to remain valid at the time health services are
provided?
A. OBRA (Omnibus Budget Reconciliation Act)
B. ACA (Affordable Care Act)
C. MMA (Medicare Prescription Drug, Improvement, and Modernization Act)
D. TEFRA (Tax Equity and Fiscal Responsibility Act)
Answer: C. MMA (Medicare Prescription Drug, Improvement, and Modernization Act)
Explanation: The MMA mandates that all code sets used for billing and reporting healthcare
services must be valid at the time services are rendered, ensuring consistency and compliance
in claims processing.
,Question 3
HIPAA requires health plans that do not accept standard code sets to either modify their
systems to accept all valid codes or contract with a __________.
A. insurance company
B. electronic data interchange (EDI) service
C. third-party administrator
D. health care clearinghouse
Answer: D. health care clearinghouse
Explanation: A healthcare clearinghouse acts as an intermediary that translates non-standard
data formats into HIPAA-compliant standard transactions, allowing plans that cannot directly
accept standard code sets to remain compliant.
Question 4
Electronic transactions submitted by providers and third-party payers, including Medicare
administrative contractors (MACs), must adhere to the Official Guidelines for Coding and
Reporting. A violation of these coding guidelines constitutes a technical violation of
__________.
A. ACA (Affordable Care Act)
B. TEFRA (Tax Equity and Fiscal Responsibility Act)
C. HIPAA (Health Insurance Portability and Accountability Act)
D. MMA (Medicare Prescription Drug, Improvement, and Modernization Act)
Answer: C. HIPAA (Health Insurance Portability and Accountability Act)
Explanation: HIPAA established administrative simplification provisions requiring
standardized electronic transactions and code sets. Noncompliance with coding guidelines
violates these HIPAA standards.
Section 2: Clinical Documentation Improvement (CDI)
, Question 5
The primary purpose of a clinical documentation improvement (CDI) program is to help
healthcare facilities comply with government programs and initiatives aimed at improving
healthcare quality. A CDI specialist initiates concurrent and retrospective reviews of inpatient
records to identify __________ provider documentation.
A. conflicting, incomplete, or nonspecific
B. illegible physician queries
C. redacted health insurance claims
D. abusive and fraudulent
Answer: A. conflicting, incomplete, or nonspecific
Explanation: CDI programs focus on identifying documentation that is conflicting
(contradictory information), incomplete (missing essential elements), or nonspecific (lacking
precision), as these issues negatively impact coding accuracy and quality metrics.
Section 3: Patient Health Records and Documentation
Question 6
A patient record serves as the business record for a patient encounter and documents
__________.
A. inaccurate information that cannot be altered
B. encounter forms data sent to third-party payers
C. insurance claims submitted to health plans
D. health care services provided to a patient
Answer: D. health care services provided to a patient
Explanation: The patient record is a legal business document that chronicles all healthcare
services delivered during an encounter, including assessments, treatments, and patient
responses.
Question 7
The electronic health record (EHR) is best defined as a __________.
A. collection of information by multiple providers at different facilities about a single patient
B. observation about how the patient responds to treatment based on test results
2026/2027: 80 Multiple-Choice Questions
with Answers & Explanations | HIPAA,
CDI, Medical Necessity, Coding Guidelines
Description:
Master medical coding for 2026/2027 with 80 realistic exam questions covering ICD-10-
CM, ICD-10-PCS, CPT, HCPCS, CDI, SOAP notes, and HIPAA compliance.
Each answer includes a detailed explanation. Perfect for RHIT, CPC, CCS, and CIC
candidates.
Download the full 2026/2027 practice exam now and pass with confidence!
, Medical Coding Exam 2026/2027: 80 Q&A
Section 1: Healthcare Regulatory and Administrative Frameworks
Question 1
The Centers for Medicare & Medicaid Services (CMS) functions as a(n) __________ within
the federal Department of Health and Human Services (DHHS).
A. private organization
B. administrative agency
C. third-party payer
D. compliance section
Answer: B. administrative agency
Explanation: CMS is a federal administrative agency operating under DHHS. It oversees
Medicare, Medicaid, and other health insurance programs, making it a governmental
regulatory and administrative body rather than a private entity or purely financial
intermediary.
Question 2
Which federal legislation requires all code sets to remain valid at the time health services are
provided?
A. OBRA (Omnibus Budget Reconciliation Act)
B. ACA (Affordable Care Act)
C. MMA (Medicare Prescription Drug, Improvement, and Modernization Act)
D. TEFRA (Tax Equity and Fiscal Responsibility Act)
Answer: C. MMA (Medicare Prescription Drug, Improvement, and Modernization Act)
Explanation: The MMA mandates that all code sets used for billing and reporting healthcare
services must be valid at the time services are rendered, ensuring consistency and compliance
in claims processing.
,Question 3
HIPAA requires health plans that do not accept standard code sets to either modify their
systems to accept all valid codes or contract with a __________.
A. insurance company
B. electronic data interchange (EDI) service
C. third-party administrator
D. health care clearinghouse
Answer: D. health care clearinghouse
Explanation: A healthcare clearinghouse acts as an intermediary that translates non-standard
data formats into HIPAA-compliant standard transactions, allowing plans that cannot directly
accept standard code sets to remain compliant.
Question 4
Electronic transactions submitted by providers and third-party payers, including Medicare
administrative contractors (MACs), must adhere to the Official Guidelines for Coding and
Reporting. A violation of these coding guidelines constitutes a technical violation of
__________.
A. ACA (Affordable Care Act)
B. TEFRA (Tax Equity and Fiscal Responsibility Act)
C. HIPAA (Health Insurance Portability and Accountability Act)
D. MMA (Medicare Prescription Drug, Improvement, and Modernization Act)
Answer: C. HIPAA (Health Insurance Portability and Accountability Act)
Explanation: HIPAA established administrative simplification provisions requiring
standardized electronic transactions and code sets. Noncompliance with coding guidelines
violates these HIPAA standards.
Section 2: Clinical Documentation Improvement (CDI)
, Question 5
The primary purpose of a clinical documentation improvement (CDI) program is to help
healthcare facilities comply with government programs and initiatives aimed at improving
healthcare quality. A CDI specialist initiates concurrent and retrospective reviews of inpatient
records to identify __________ provider documentation.
A. conflicting, incomplete, or nonspecific
B. illegible physician queries
C. redacted health insurance claims
D. abusive and fraudulent
Answer: A. conflicting, incomplete, or nonspecific
Explanation: CDI programs focus on identifying documentation that is conflicting
(contradictory information), incomplete (missing essential elements), or nonspecific (lacking
precision), as these issues negatively impact coding accuracy and quality metrics.
Section 3: Patient Health Records and Documentation
Question 6
A patient record serves as the business record for a patient encounter and documents
__________.
A. inaccurate information that cannot be altered
B. encounter forms data sent to third-party payers
C. insurance claims submitted to health plans
D. health care services provided to a patient
Answer: D. health care services provided to a patient
Explanation: The patient record is a legal business document that chronicles all healthcare
services delivered during an encounter, including assessments, treatments, and patient
responses.
Question 7
The electronic health record (EHR) is best defined as a __________.
A. collection of information by multiple providers at different facilities about a single patient
B. observation about how the patient responds to treatment based on test results
