CDIP PRACTICE EXAM 2025/ 2026
QUESTIONS WITH VERIFIED
ANSWERS
This type of services are billed the same as outpatient services.
a.Inpatient
b.Observation
c.Surgery
d.Acute - correct answer -b The purpose of observation is to
provide services to determine whether the patient should be
admitted as an inpatient or released from the hospital.
Observation services are billed the same as all other outpatient
services (CMS n.d.)
In review of a billing abstract, it is noted the narrative is too
lengthy and inconsistent with facility reporting. The facility HIM
department should:
a.shorten the narrative
b.change the narrative to what is acceptable at the facility
c.never change the narrative on the billing abstract
d.utilize abbreviations - correct answer -c Coding professionals
should not change codes or the narratives of codes on the
,billing abstract so that meanings are misrepresented.
Diagnoses or procedures should not be inappropriately
included or excluded because payment or insurance policy
coverage requirements will be affected. When individual payer
policies conflict with official coding rules and guidelines, these
policies should be obtained in writing whenever possible
(Bronnert 2005, 108, 110, 112).
Medicare publishes policies that define specific International
Classification of Diseases (ICD) codes that support medical
necessity for many services provided. These policies are
called:
a.local coverage determinations
b.national coverage determinations
c.coding policy determinations
d.Both a and b - correct answer -d Medicare's national
coverage policies are known as national coverage
determinations (NCDs), and local fiscal intermediary policies
are known as local coverage determinations (LCDs). These
policies define the specific International Classification of
Diseases (ICD) diagnosis codes that support medical necessity
for many services provided (Malmgren and Solberg 2011, 462).
The primary responsibility of a coder is to:
,a.Ensure timely processing of coded data
b.Ensure quality of coded data
c.Avoid claims rejections by third-party payers
d.Ensure maximum reimbursement for the facility - correct
answer -b The coding professional's first responsibility is to
ensure the accuracy of coded data. To this end, AHIMA has
established a code of professional ethics by which coders must
abide (Shaw and Carter 2014; LaTour et al. 2013, 442).
The practice of using a code that results in a higher payment to
the provider than the code that actually reflects the service or
item provided is known as:
a.unbundling
b.upcoding
c.medically unnecessary services
d.billing for services not provided - correct answer -b Upcoding
is the practice of using a code that results in a higher payment
to the provider that actually reflects the service or item provided
(Shaw and Carter 2014; Schraffenberger and Kuehn 2011,
372).
, If a service is determined to be reasonable and necessary for
the related diagnosis or treatment of illness or injury, it is stated
as being:
a.Needed for treatment
b.Medically justified
c.Noncovered
d.Medically necessary - correct answer -d The determination
that a service is reasonable and necessary for the related
diagnosis or treatment of illness or injury is determined to be
medically necessary (Shaw and Carter 2014; Malmgren and
Solberg 2011, 462).
According to Joint Commission Accreditation Standards, which
document must be placed in the patient's record before a
surgical procedure may be performed?
a.Admission record
b.Physician's order
c.Report of history and physical examination
d.Discharge summary - correct answer -c Except in emergency
situations, every surgical patient's chart must include a report
of a complete history and physical conducted no more than
seven days before the surgery is to be performed (Shaw and
Carter 2014; Fahrenholz and Russo 2013, 238).
QUESTIONS WITH VERIFIED
ANSWERS
This type of services are billed the same as outpatient services.
a.Inpatient
b.Observation
c.Surgery
d.Acute - correct answer -b The purpose of observation is to
provide services to determine whether the patient should be
admitted as an inpatient or released from the hospital.
Observation services are billed the same as all other outpatient
services (CMS n.d.)
In review of a billing abstract, it is noted the narrative is too
lengthy and inconsistent with facility reporting. The facility HIM
department should:
a.shorten the narrative
b.change the narrative to what is acceptable at the facility
c.never change the narrative on the billing abstract
d.utilize abbreviations - correct answer -c Coding professionals
should not change codes or the narratives of codes on the
,billing abstract so that meanings are misrepresented.
Diagnoses or procedures should not be inappropriately
included or excluded because payment or insurance policy
coverage requirements will be affected. When individual payer
policies conflict with official coding rules and guidelines, these
policies should be obtained in writing whenever possible
(Bronnert 2005, 108, 110, 112).
Medicare publishes policies that define specific International
Classification of Diseases (ICD) codes that support medical
necessity for many services provided. These policies are
called:
a.local coverage determinations
b.national coverage determinations
c.coding policy determinations
d.Both a and b - correct answer -d Medicare's national
coverage policies are known as national coverage
determinations (NCDs), and local fiscal intermediary policies
are known as local coverage determinations (LCDs). These
policies define the specific International Classification of
Diseases (ICD) diagnosis codes that support medical necessity
for many services provided (Malmgren and Solberg 2011, 462).
The primary responsibility of a coder is to:
,a.Ensure timely processing of coded data
b.Ensure quality of coded data
c.Avoid claims rejections by third-party payers
d.Ensure maximum reimbursement for the facility - correct
answer -b The coding professional's first responsibility is to
ensure the accuracy of coded data. To this end, AHIMA has
established a code of professional ethics by which coders must
abide (Shaw and Carter 2014; LaTour et al. 2013, 442).
The practice of using a code that results in a higher payment to
the provider than the code that actually reflects the service or
item provided is known as:
a.unbundling
b.upcoding
c.medically unnecessary services
d.billing for services not provided - correct answer -b Upcoding
is the practice of using a code that results in a higher payment
to the provider that actually reflects the service or item provided
(Shaw and Carter 2014; Schraffenberger and Kuehn 2011,
372).
, If a service is determined to be reasonable and necessary for
the related diagnosis or treatment of illness or injury, it is stated
as being:
a.Needed for treatment
b.Medically justified
c.Noncovered
d.Medically necessary - correct answer -d The determination
that a service is reasonable and necessary for the related
diagnosis or treatment of illness or injury is determined to be
medically necessary (Shaw and Carter 2014; Malmgren and
Solberg 2011, 462).
According to Joint Commission Accreditation Standards, which
document must be placed in the patient's record before a
surgical procedure may be performed?
a.Admission record
b.Physician's order
c.Report of history and physical examination
d.Discharge summary - correct answer -c Except in emergency
situations, every surgical patient's chart must include a report
of a complete history and physical conducted no more than
seven days before the surgery is to be performed (Shaw and
Carter 2014; Fahrenholz and Russo 2013, 238).
