CCA Exam Preparation Domains 1, 2, 3, 4,
5, & 6 Practice Test
1. A patient is admitted with spotting. She had been treated two weeks previously for a
miscarriage with sepsis. The sepsis had resolved, and she is afebrile at this time. She is
treated with an aspiration dilation and curettage and products of conception are found.
Which of the following should be the principal diagnosis?
a. Miscarriage
b. Complications of spontaneous abortion with sepsis
c. Sepsis
d. Spontaneous abortion with sepsis - ANS-a. Miscarriage
10. Reference codes 49491 through 49525 for inguinal hernia repair. Patient is 47 years
old. What is the correct code for an initial inguinal herniorrhaphy for incarcerated
hernia?
a. 49496
b. 49501
c. 49507
d. 49521 - ANS-c. 49507
100. From the information provided, how many APCs would this patient have?
Billing Number Status Indicator CPT/HCPCS APC
998323 V 99285-25 0612
998324 T 25500 0044
998325 X 72050 0261
998326 S 72128 0283
998327 S 70450 0283
a. 1
b. 4
c. 5
d. 3 - ANS-c. 5
101. What statement is not reflective of meeting medical necessity requirements?
,a. A service or supply provided for the diagnosis, treatment, cure, or relief of a health
condition, illness, injury, or disease.
b. A service or supply provided that is not experimental, investigational, or cosmetic in
purpose.
c. A service provided that is necessary for and appropriate to the diagnosis, treatment,
cure, or relief of a health condition, illness, injury, disease, or its symptoms.
d. A service provided solely for the convenience of the insured, the insured's family, or
the provider. - ANS-d. A service provided solely for the convenience of the insured, the
insured's family, or the provider.
102. In a managed fee-for-service arrangement, which of the following would be used
as a cost-control process for inpatient surgical services?
a. Prospectively precertify the necessity of inpatient services
b. Determine what services can be bundled
c. Pay only 80 percent of the inpatient bill
d. Require the patient to pay 20 percent of the inpatient bill - ANS-a. Prospectively
precertify the necessity of inpatient services
103. If a patient's total outpatient bill is $500, and the patient's healthcare insurance
plan pays 80 percent of the allowable charges, what is the amount owed by the patient?
a. $10
b. $40
c. $100
d. $400 - ANS-c. $100
104. What system reimburses hospitals a predetermined amount for each Medicare
inpatient admission?
a. APR-DRG
b. DRG
c. APC
d. RUG - ANS-b. DRG
105. Timely and correct reimbursement is dependent on:
a. Adjudication
b. Clean claims
c. Remittance advice
,d. Actual charge - ANS-b. Clean claims
106. When a provider accepts assignment, this means the:
a. Patient authorizes payment to be made directly to the provider
b. Provider agrees to accept as payment in full the allowed charge from the fee
schedule
c. Balance billing is allowed on patient accounts, but at a limited rate
d. Participating provider receives a fee-for-service reimbursement - ANS-b. Provider
agrees to accept as payment in full the allowed charge from the fee schedule
107. Effective October 16, 2003, under the Administrative Simplification Compliance
section of the Health Insurance Portability and Accountability Act of 1996 (HIPAA), all
healthcare providers must electronically submit claims to Medicare. Which is the
electronic format for hospital technical fees?
a. 837I
b. 837P
c. UB-04
d. 1500 - ANS-a. 837I
108. Given the following information, which of the following statements is correct?
Weight Discharges Geometric Mean Arithmetic Mean
0.9757 10 4.1 5.0
0.7254 20 3.3 4.0
1.4327 10 5.4 6.7
1.0056 20 4.4 5.3
0.7316 10 3.5 4.1
a. In each MS-DRG the geometric mean is lower than the arithmetic mean.
b. In each MS-DRG the arithmetic mean is lower than the geometric mean.
c. The higher the number of patients in each MS-DRG, the greater the geometric mean
for that MS-DRG.
d. The geometric means are lower in MS-DRGs that are associated with a CC or MCC.
- ANS-a. In each MS-DRG the geometric mean is lower than the arithmetic mean.
109. Promoting correct coding and control of inappropriate payments is the basis of
NCCI claims processing edits that help identify claims not meeting medical necessity.
, The NCCI automated prepayment edits used by payers is based on all of the following
except:
a. Coding conventions defined in the CPT book
b. National and local policies and coding edits
c. Analysis of standard medical and surgical practice
d. Clinical documentation in the discharge summary - ANS-d. Clinical documentation in
the discharge summary
11. A patient was admitted for abdominal pain with diarrhea and was diagnosed with
infectious gastroenteritis. The patient also has angina and chronic obstructive
pulmonary disease. Which of the following would be the correct coding and sequencing
for this case?
a. Abdominal pain; infectious gastroenteritis; chronic obstructive pulmonary disease;
angina
b. Infectious gastroenteritis; chronic obstructive pulmonary disease; angina
c. Gastroenteritis; abdominal pain; angina
d. Gastroenteritis; abdominal pain; diarrhea; chronic obstructive pulmonary disease;
angina - ANS-b. Infectious gastroenteritis; chronic obstructive pulmonary disease;
angina
110. The NCCI editing system used in processing OPPS claims is referred to as:
a. Outpatient code editor (OCE)
b. Outpatient national editor (ONE)
c. Outpatient perspective payment editor (OPPE)
d. Outpatient claims editor (OCE) - ANS-a. Outpatient code editor (OCE)
111. In the acute care facility, the patient identity management tool that ensures that the
right patient connects to the right information relies on:
a. Master Patient Index (MPI)
b. Case Mix Index (CMI)
c. The Organization's clinical staff
d. Cancer Registry - ANS-a. Master Patient Index (MPI)
112. What is the function of a consultation report?
a. Provides a chronological summary of the patient's medical history and illness
5, & 6 Practice Test
1. A patient is admitted with spotting. She had been treated two weeks previously for a
miscarriage with sepsis. The sepsis had resolved, and she is afebrile at this time. She is
treated with an aspiration dilation and curettage and products of conception are found.
Which of the following should be the principal diagnosis?
a. Miscarriage
b. Complications of spontaneous abortion with sepsis
c. Sepsis
d. Spontaneous abortion with sepsis - ANS-a. Miscarriage
10. Reference codes 49491 through 49525 for inguinal hernia repair. Patient is 47 years
old. What is the correct code for an initial inguinal herniorrhaphy for incarcerated
hernia?
a. 49496
b. 49501
c. 49507
d. 49521 - ANS-c. 49507
100. From the information provided, how many APCs would this patient have?
Billing Number Status Indicator CPT/HCPCS APC
998323 V 99285-25 0612
998324 T 25500 0044
998325 X 72050 0261
998326 S 72128 0283
998327 S 70450 0283
a. 1
b. 4
c. 5
d. 3 - ANS-c. 5
101. What statement is not reflective of meeting medical necessity requirements?
,a. A service or supply provided for the diagnosis, treatment, cure, or relief of a health
condition, illness, injury, or disease.
b. A service or supply provided that is not experimental, investigational, or cosmetic in
purpose.
c. A service provided that is necessary for and appropriate to the diagnosis, treatment,
cure, or relief of a health condition, illness, injury, disease, or its symptoms.
d. A service provided solely for the convenience of the insured, the insured's family, or
the provider. - ANS-d. A service provided solely for the convenience of the insured, the
insured's family, or the provider.
102. In a managed fee-for-service arrangement, which of the following would be used
as a cost-control process for inpatient surgical services?
a. Prospectively precertify the necessity of inpatient services
b. Determine what services can be bundled
c. Pay only 80 percent of the inpatient bill
d. Require the patient to pay 20 percent of the inpatient bill - ANS-a. Prospectively
precertify the necessity of inpatient services
103. If a patient's total outpatient bill is $500, and the patient's healthcare insurance
plan pays 80 percent of the allowable charges, what is the amount owed by the patient?
a. $10
b. $40
c. $100
d. $400 - ANS-c. $100
104. What system reimburses hospitals a predetermined amount for each Medicare
inpatient admission?
a. APR-DRG
b. DRG
c. APC
d. RUG - ANS-b. DRG
105. Timely and correct reimbursement is dependent on:
a. Adjudication
b. Clean claims
c. Remittance advice
,d. Actual charge - ANS-b. Clean claims
106. When a provider accepts assignment, this means the:
a. Patient authorizes payment to be made directly to the provider
b. Provider agrees to accept as payment in full the allowed charge from the fee
schedule
c. Balance billing is allowed on patient accounts, but at a limited rate
d. Participating provider receives a fee-for-service reimbursement - ANS-b. Provider
agrees to accept as payment in full the allowed charge from the fee schedule
107. Effective October 16, 2003, under the Administrative Simplification Compliance
section of the Health Insurance Portability and Accountability Act of 1996 (HIPAA), all
healthcare providers must electronically submit claims to Medicare. Which is the
electronic format for hospital technical fees?
a. 837I
b. 837P
c. UB-04
d. 1500 - ANS-a. 837I
108. Given the following information, which of the following statements is correct?
Weight Discharges Geometric Mean Arithmetic Mean
0.9757 10 4.1 5.0
0.7254 20 3.3 4.0
1.4327 10 5.4 6.7
1.0056 20 4.4 5.3
0.7316 10 3.5 4.1
a. In each MS-DRG the geometric mean is lower than the arithmetic mean.
b. In each MS-DRG the arithmetic mean is lower than the geometric mean.
c. The higher the number of patients in each MS-DRG, the greater the geometric mean
for that MS-DRG.
d. The geometric means are lower in MS-DRGs that are associated with a CC or MCC.
- ANS-a. In each MS-DRG the geometric mean is lower than the arithmetic mean.
109. Promoting correct coding and control of inappropriate payments is the basis of
NCCI claims processing edits that help identify claims not meeting medical necessity.
, The NCCI automated prepayment edits used by payers is based on all of the following
except:
a. Coding conventions defined in the CPT book
b. National and local policies and coding edits
c. Analysis of standard medical and surgical practice
d. Clinical documentation in the discharge summary - ANS-d. Clinical documentation in
the discharge summary
11. A patient was admitted for abdominal pain with diarrhea and was diagnosed with
infectious gastroenteritis. The patient also has angina and chronic obstructive
pulmonary disease. Which of the following would be the correct coding and sequencing
for this case?
a. Abdominal pain; infectious gastroenteritis; chronic obstructive pulmonary disease;
angina
b. Infectious gastroenteritis; chronic obstructive pulmonary disease; angina
c. Gastroenteritis; abdominal pain; angina
d. Gastroenteritis; abdominal pain; diarrhea; chronic obstructive pulmonary disease;
angina - ANS-b. Infectious gastroenteritis; chronic obstructive pulmonary disease;
angina
110. The NCCI editing system used in processing OPPS claims is referred to as:
a. Outpatient code editor (OCE)
b. Outpatient national editor (ONE)
c. Outpatient perspective payment editor (OPPE)
d. Outpatient claims editor (OCE) - ANS-a. Outpatient code editor (OCE)
111. In the acute care facility, the patient identity management tool that ensures that the
right patient connects to the right information relies on:
a. Master Patient Index (MPI)
b. Case Mix Index (CMI)
c. The Organization's clinical staff
d. Cancer Registry - ANS-a. Master Patient Index (MPI)
112. What is the function of a consultation report?
a. Provides a chronological summary of the patient's medical history and illness
