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AHIMA CCS EXAM PREP 2025 MULTICHOICE ANSWERED EXAM
QUESTIONS WITH DETAILED RATIONALES
1. CPT defines a “separate procedure” as:
A. A code that bundles several services together
B. A routine service performed during hospitalization
C. A procedure considered an integral part of a more major service
D. A procedure that always requires modifier -59
Answer: C. A procedure considered an integral part of a more major service
Rationale: A “separate procedure” is typically not billed separately unless
documentation supports it as distinct from the major service.
2. When “no combination code is available” for two coexisting conditions (e.g.,
hypertension and acute renal failure), you should:
A. Use only the primary diagnosis code
B. Use an unspecified code for both
C. Use separate codes for hypertension and acute renal failure
D. Report as one code with modifier -25
Answer: C. Use separate codes for hypertension and acute renal failure
Rationale: If no combination code exists, each condition is coded separately to reflect
clinical complexity.
3. Documentation from nursing or allied health notes may be used to provide specificity
for which diagnosis element?
A. Smoking history
B. Family history of disease
C. Body Mass Index (BMI)
D. Definitive surgical findings
Answer: C. Body Mass Index (BMI)
Rationale: Nursing-documented height/weight/BMI can be acceptable for coding BMI
when organizational policy allows.
4. POA Indicator – Y means:
A. Yes, confirmed after discharge
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B. Yes, present at the time of inpatient admission
C. Yes, present on arrival to the emergency room only
D. Yes, but only for outpatient encounters
Answer: B. Yes, present at the time of inpatient admission
Rationale: POA Y indicates the condition existed on admission and generally will not be
treated as a HAC for payment adjustment.
5. POA Indicator – U stands for:
A. Unacceptable documentation
B. Unreported by the facility
C. Unknown — documentation insufficient to determine POA
D. Upgraded condition on discharge
Answer: C. Unknown — documentation insufficient to determine POA
Rationale: U indicates insufficient documentation and inability to consult the provider
for clarification.
6. The Outpatient Code Editor (OCE) is designed to:
A. Edit inpatient medical records only
B. Approve all claims automatically
C. Identify incomplete and incorrect claims
D. Replace clinical documentation improvement (CDI) staff
Answer: C. Identify incomplete and incorrect claims
Rationale: OCE flags coding/claim issues for correction prior to payment.
7. Medicare’s documentation of medical necessity and coverage is outlined in:
A. National Coverage Decisions (NCDs) only
B. Local physician policies
C. Local Coverage Determinations (LCDs)
D. CPT Assistant articles
Answer: C. Local Coverage Determinations (LCDs)
Rationale: LCDs specify regional policies for medical necessity and may be used by
contractors.
, ESTUDYR
8. Medically unlikely edits (MUEs) are used to identify:
A. Unbundling of CPT codes
B. Duplicate claims across providers
C. Maximum units of service for a HCPCS/CPT code
D. Patient-level POA issues
Answer: C. Maximum units of service for a HCPCS/CPT code
Rationale: MUEs prevent unlikely high unit counts that indicate billing errors or abuse.
9. NCCI edits (National Correct Coding Initiative) are released how often?
A. Monthly
B. Annually
C. Quarterly
D. Biannually
Answer: C. Quarterly
Rationale: CMS publishes NCCI updates on a quarterly schedule.
10. The outpatient prospective payment system (OPPS) final rule in 2000 primarily:
A. Eliminated APCs
B. Created ICD-10-PCS codes
C. Divided outpatient services into fixed payment groups
D. Standardized in-patient payments worldwide
Answer: C. Divided outpatient services into fixed payment groups
Rationale: OPPS groups outpatient procedures into APCs for facility payment.
11. APCs (Ambulatory Payment Classifications) are:
A. Used for physician payment only
B. Proprietary to private insurers
C. Medicare’s method to pay facilities for outpatient services
D. Used exclusively for inpatient DRG assignment
Answer: C. Medicare’s method to pay facilities for outpatient services
Rationale: APCs are facility-level outpatient prospective payment groups under OPPS.
AHIMA CCS EXAM PREP 2025 MULTICHOICE ANSWERED EXAM
QUESTIONS WITH DETAILED RATIONALES
1. CPT defines a “separate procedure” as:
A. A code that bundles several services together
B. A routine service performed during hospitalization
C. A procedure considered an integral part of a more major service
D. A procedure that always requires modifier -59
Answer: C. A procedure considered an integral part of a more major service
Rationale: A “separate procedure” is typically not billed separately unless
documentation supports it as distinct from the major service.
2. When “no combination code is available” for two coexisting conditions (e.g.,
hypertension and acute renal failure), you should:
A. Use only the primary diagnosis code
B. Use an unspecified code for both
C. Use separate codes for hypertension and acute renal failure
D. Report as one code with modifier -25
Answer: C. Use separate codes for hypertension and acute renal failure
Rationale: If no combination code exists, each condition is coded separately to reflect
clinical complexity.
3. Documentation from nursing or allied health notes may be used to provide specificity
for which diagnosis element?
A. Smoking history
B. Family history of disease
C. Body Mass Index (BMI)
D. Definitive surgical findings
Answer: C. Body Mass Index (BMI)
Rationale: Nursing-documented height/weight/BMI can be acceptable for coding BMI
when organizational policy allows.
4. POA Indicator – Y means:
A. Yes, confirmed after discharge
,ESTUDYR
B. Yes, present at the time of inpatient admission
C. Yes, present on arrival to the emergency room only
D. Yes, but only for outpatient encounters
Answer: B. Yes, present at the time of inpatient admission
Rationale: POA Y indicates the condition existed on admission and generally will not be
treated as a HAC for payment adjustment.
5. POA Indicator – U stands for:
A. Unacceptable documentation
B. Unreported by the facility
C. Unknown — documentation insufficient to determine POA
D. Upgraded condition on discharge
Answer: C. Unknown — documentation insufficient to determine POA
Rationale: U indicates insufficient documentation and inability to consult the provider
for clarification.
6. The Outpatient Code Editor (OCE) is designed to:
A. Edit inpatient medical records only
B. Approve all claims automatically
C. Identify incomplete and incorrect claims
D. Replace clinical documentation improvement (CDI) staff
Answer: C. Identify incomplete and incorrect claims
Rationale: OCE flags coding/claim issues for correction prior to payment.
7. Medicare’s documentation of medical necessity and coverage is outlined in:
A. National Coverage Decisions (NCDs) only
B. Local physician policies
C. Local Coverage Determinations (LCDs)
D. CPT Assistant articles
Answer: C. Local Coverage Determinations (LCDs)
Rationale: LCDs specify regional policies for medical necessity and may be used by
contractors.
, ESTUDYR
8. Medically unlikely edits (MUEs) are used to identify:
A. Unbundling of CPT codes
B. Duplicate claims across providers
C. Maximum units of service for a HCPCS/CPT code
D. Patient-level POA issues
Answer: C. Maximum units of service for a HCPCS/CPT code
Rationale: MUEs prevent unlikely high unit counts that indicate billing errors or abuse.
9. NCCI edits (National Correct Coding Initiative) are released how often?
A. Monthly
B. Annually
C. Quarterly
D. Biannually
Answer: C. Quarterly
Rationale: CMS publishes NCCI updates on a quarterly schedule.
10. The outpatient prospective payment system (OPPS) final rule in 2000 primarily:
A. Eliminated APCs
B. Created ICD-10-PCS codes
C. Divided outpatient services into fixed payment groups
D. Standardized in-patient payments worldwide
Answer: C. Divided outpatient services into fixed payment groups
Rationale: OPPS groups outpatient procedures into APCs for facility payment.
11. APCs (Ambulatory Payment Classifications) are:
A. Used for physician payment only
B. Proprietary to private insurers
C. Medicare’s method to pay facilities for outpatient services
D. Used exclusively for inpatient DRG assignment
Answer: C. Medicare’s method to pay facilities for outpatient services
Rationale: APCs are facility-level outpatient prospective payment groups under OPPS.
