1|Page
2025 AAPC CPC (CERTIFIED PROFESSIONAL CODER) FINAL
EXAM WITH 200 ACCURATE AND VERIFIED QUESTIONS
COVERING MEDICAL CODING GUIDELINES, CPT, ICD-10-CM,
HCPCS LEVEL II, COMPLIANCE, AND CODING SCENARIOS.
Who would NOT be considered a covered entity under HIPAA?
A. Doctors
B. HMO's
C. Clearinghouse
D. Patient (pt.) - ANSWER-D. Patient (pt.)
Explanation: Patients are not covered entities themselves. They are the subjects of HIPAA
regulations, but they do not have the obligations imposed on covered entities
Under HIPPA, what would be a policy requirement for "Minimum Necessary"?
A. Only individuals whose jobs requires it may have access to protected health information.
B. Only the pt. has access to protected health information.
C. Only the physician has access to protected health information.
D. Anyone within the provider's office can have access to the protected health information. -
ANSWER-A. Only individuals whose jobs requires it may have access to protected health
information.
Explanation: The HIPAA Minimum Necessary rule mandates that healthcare providers only
access and disclose the minimum amount of Protected Health Information (PHI) needed to
fulfill a specific purpose. This means that only authorized personnel who directly need the
information for their job functions should have access to it.
,2|Page
Which Act with enacted as part as the American Recovery and Reinvestment Act of 2009 (ARRA)
and affected privacy and security?
A. HIPAA
B. HIITECH
C. SSA
D. FECA - ANSWER-B. HITECH
Explanation: The Health Information Technology for Economic and Clinical Health (HITECH) Act
was enacted as part of the American Recovery and Reinvestment Act (ARRA) in 2009. HITECH
specifically focuses on strengthening the privacy and security provisions of HIPAA by expanding
enforcement mechanisms and promoting the adoption of electronic health records (EHRs).
What document has been created to assist physician offices with the development of
compliance manuals ?
A. OIG Compliance Plan Guidance
B. OIG Work Plan
C. OIG Suggested Rules and Regulations
D. OIG Internal Compliance Plan - ANSWER-A. OIG Compliance Plan Guidance
Explanation: The OIG Compliance Plan Guidance, issued by the Office of Inspector General
(OIG), provides guidance and recommendations to healthcare providers on how to establish and
maintain a compliant compliance program, including the development of compliance manuals.
What document should be referred to when looking for potential problem areas identified by
the government indicating scrutiny of the services within the coming year?
,3|Page
A. OIG Compliance Plan Guidance
B. OIG Security Summary
C. OIG Work Plan
D. OIG Document Planner - ANSWER-C. OIG Work Plan
Explanation: The OIG Work Plan, published annually by the Office of Inspector General (OIG),
outlines the areas the OIG intends to focus on during the upcoming year, making it a crucial
document for healthcare providers to review to anticipate potential compliance issues.
A professional organization representing physicians and medical students in the United
States.Established in 1847, aims to promote the art and science of medicine, improve public
health, and advocate for the interests of its members. - ANSWER-American Medical Association
(AMA)
A system used by the Centers for Medicare & Medicaid Services (CMS) to reimburse hospitals
for outpatient services. They group outpatient procedures together based on similar clinical
characteristics and resource utilization, then assign a fixed, prospective payment for each group.
This system encourages hospitals to provide efficient and cost-effective outpatient care. -
ANSWER-Ambulatory Payment Classification (APC)
Also known as the "stimulus", was a federal law enacted to address the Great Recession. It
aimed to stimulate the economy by providing financial relief, investing in infrastructure and
energy efficiency, and supporting education and healthcare - ANSWER-American Recovery and
Reinvestment Act of 2009 (ARRA)
Providing surgical services to patients who do not require hospitalization and expected duration
of services does not exceed 24 hours. - ANSWER-Ambulatory Surgical Centers (ASC)
, 4|Page
Refers to a standardized code set developed by the American Dental Association (ADA) for
reporting dental procedures and services on dental benefit claims.
It provides a universal language for describing dental treatments and services, facilitating
efficient processing of dental claims and insurance reimbursement. - ANSWER-Current Dental
Technology (CDT)
A healthcare professional who specializes in translating medical procedures, diagnoses, and
services into standardized codes for billing purposes. - ANSWER-Certified Professional Coder
(CPC)
A standard vocabulary for surgical procedures, minor procedures that physicians perform in the
office, radiology tests, and a small number of laboratory tests. - ANSWER-Current Procedural
Terminology (CPT)
A digital collection of a patient's medical information that is stored and accessed electronically.
(Demographics, Medical history, Diagnoses, Medications, Allergies, Immunizations, Lab results,
and Radiology images). - ANSWER-Electronic Health Record (EHR)
Refers to the cognitive services provided by a physician or other qualified healthcare
professional to diagnose and treat a patient's illness or injury. It's not about a specific procedure
or test, but rather the overall assessment, planning, and management of a patient's health over
time. - ANSWER-Evaluation & Management (E/M or E&M)
A set of standardized codes used in medical billing to represent procedures, supplies, products,
and services provided to patients, primarily for billing to Medicare, Medicaid, and other third-
party payers. - ANSWER-Healthcare Common Procedure Coding System (HCPCS)
A U.S. federal government agency responsible for protecting the public's health and providing
essential human services. It oversees programs and policies related to public health, social
welfare, and income security. - ANSWER-Department of Health & Human Services (HHS)
2025 AAPC CPC (CERTIFIED PROFESSIONAL CODER) FINAL
EXAM WITH 200 ACCURATE AND VERIFIED QUESTIONS
COVERING MEDICAL CODING GUIDELINES, CPT, ICD-10-CM,
HCPCS LEVEL II, COMPLIANCE, AND CODING SCENARIOS.
Who would NOT be considered a covered entity under HIPAA?
A. Doctors
B. HMO's
C. Clearinghouse
D. Patient (pt.) - ANSWER-D. Patient (pt.)
Explanation: Patients are not covered entities themselves. They are the subjects of HIPAA
regulations, but they do not have the obligations imposed on covered entities
Under HIPPA, what would be a policy requirement for "Minimum Necessary"?
A. Only individuals whose jobs requires it may have access to protected health information.
B. Only the pt. has access to protected health information.
C. Only the physician has access to protected health information.
D. Anyone within the provider's office can have access to the protected health information. -
ANSWER-A. Only individuals whose jobs requires it may have access to protected health
information.
Explanation: The HIPAA Minimum Necessary rule mandates that healthcare providers only
access and disclose the minimum amount of Protected Health Information (PHI) needed to
fulfill a specific purpose. This means that only authorized personnel who directly need the
information for their job functions should have access to it.
,2|Page
Which Act with enacted as part as the American Recovery and Reinvestment Act of 2009 (ARRA)
and affected privacy and security?
A. HIPAA
B. HIITECH
C. SSA
D. FECA - ANSWER-B. HITECH
Explanation: The Health Information Technology for Economic and Clinical Health (HITECH) Act
was enacted as part of the American Recovery and Reinvestment Act (ARRA) in 2009. HITECH
specifically focuses on strengthening the privacy and security provisions of HIPAA by expanding
enforcement mechanisms and promoting the adoption of electronic health records (EHRs).
What document has been created to assist physician offices with the development of
compliance manuals ?
A. OIG Compliance Plan Guidance
B. OIG Work Plan
C. OIG Suggested Rules and Regulations
D. OIG Internal Compliance Plan - ANSWER-A. OIG Compliance Plan Guidance
Explanation: The OIG Compliance Plan Guidance, issued by the Office of Inspector General
(OIG), provides guidance and recommendations to healthcare providers on how to establish and
maintain a compliant compliance program, including the development of compliance manuals.
What document should be referred to when looking for potential problem areas identified by
the government indicating scrutiny of the services within the coming year?
,3|Page
A. OIG Compliance Plan Guidance
B. OIG Security Summary
C. OIG Work Plan
D. OIG Document Planner - ANSWER-C. OIG Work Plan
Explanation: The OIG Work Plan, published annually by the Office of Inspector General (OIG),
outlines the areas the OIG intends to focus on during the upcoming year, making it a crucial
document for healthcare providers to review to anticipate potential compliance issues.
A professional organization representing physicians and medical students in the United
States.Established in 1847, aims to promote the art and science of medicine, improve public
health, and advocate for the interests of its members. - ANSWER-American Medical Association
(AMA)
A system used by the Centers for Medicare & Medicaid Services (CMS) to reimburse hospitals
for outpatient services. They group outpatient procedures together based on similar clinical
characteristics and resource utilization, then assign a fixed, prospective payment for each group.
This system encourages hospitals to provide efficient and cost-effective outpatient care. -
ANSWER-Ambulatory Payment Classification (APC)
Also known as the "stimulus", was a federal law enacted to address the Great Recession. It
aimed to stimulate the economy by providing financial relief, investing in infrastructure and
energy efficiency, and supporting education and healthcare - ANSWER-American Recovery and
Reinvestment Act of 2009 (ARRA)
Providing surgical services to patients who do not require hospitalization and expected duration
of services does not exceed 24 hours. - ANSWER-Ambulatory Surgical Centers (ASC)
, 4|Page
Refers to a standardized code set developed by the American Dental Association (ADA) for
reporting dental procedures and services on dental benefit claims.
It provides a universal language for describing dental treatments and services, facilitating
efficient processing of dental claims and insurance reimbursement. - ANSWER-Current Dental
Technology (CDT)
A healthcare professional who specializes in translating medical procedures, diagnoses, and
services into standardized codes for billing purposes. - ANSWER-Certified Professional Coder
(CPC)
A standard vocabulary for surgical procedures, minor procedures that physicians perform in the
office, radiology tests, and a small number of laboratory tests. - ANSWER-Current Procedural
Terminology (CPT)
A digital collection of a patient's medical information that is stored and accessed electronically.
(Demographics, Medical history, Diagnoses, Medications, Allergies, Immunizations, Lab results,
and Radiology images). - ANSWER-Electronic Health Record (EHR)
Refers to the cognitive services provided by a physician or other qualified healthcare
professional to diagnose and treat a patient's illness or injury. It's not about a specific procedure
or test, but rather the overall assessment, planning, and management of a patient's health over
time. - ANSWER-Evaluation & Management (E/M or E&M)
A set of standardized codes used in medical billing to represent procedures, supplies, products,
and services provided to patients, primarily for billing to Medicare, Medicaid, and other third-
party payers. - ANSWER-Healthcare Common Procedure Coding System (HCPCS)
A U.S. federal government agency responsible for protecting the public's health and providing
essential human services. It oversees programs and policies related to public health, social
welfare, and income security. - ANSWER-Department of Health & Human Services (HHS)
