CERTIFIED PROFESSIONAL CODER
EXAMINATION QUESTIONS AND
CORRECT ANSWERS (VERIFIED
ANSWERS) PLUS RATIONALES 2026 Q&A
| INSTANT DOWNLOAD PDF
1. What is the purpose of ICD-10-CM?
A. To report hospital reimbursement rates
B. To classify diagnoses and reasons for encounters
C. To report inpatient procedures
D. To identify supply charges
Answer: B
Rationale: ICD-10-CM is strictly for reporting diagnoses and encounter reasons,
not procedures or supplies.
2. What is CPT used for?
A. Classifying diseases
B. Tracking mortality
C. Reporting outpatient procedures and services
D. Reporting inpatient procedures
Answer: C
Rationale: CPT codes describe medical, surgical, and diagnostic outpatient
services.
3. HCPCS Level II codes primarily report:
A. Physician services
B. Surgical approaches
,C. Supplies, DME, and drugs
D. Pathology services
Answer: C
Rationale: HCPCS Level II covers non-physician items such as supplies and drugs.
4. Modifier 25 indicates:
A. Significant surgical procedure
B. Reduced services
C. Significant, separately identifiable E/M service
D. Two surgeons
Answer: C
Rationale: Modifier 25 adds clarity that an E/M service was unrelated to a
same-day procedure.
5. Which entity maintains CPT?
A. CMS
B. WHO
C. AMA
D. CDC
Answer: C
Rationale: The American Medical Association owns and maintains CPT.
6. “Established patient” means the patient was seen within:
A. 2 years
B. 1 year
C. 3 years
D. 5 years
Answer: C
Rationale: CPT defines established patients as those seen by the provider/group
within 3 years.
7. What is upcoding?
, A. Adding modifiers incorrectly
B. Coding higher than documentation supports
C. Omitting codes
D. Billing multiple providers
Answer: B
Rationale: Upcoding results in inappropriate higher reimbursement.
8. A global surgical package includes:
A. New unrelated visits
B. Only the surgery
C. Preoperative, intraoperative, and routine postoperative care
D. Lab tests
Answer: C
Rationale: The global period includes routine care before and after surgery.
9. An NCCI edit prevents:
A. E/M reporting
B. Billing two services that shouldn’t be paid together
C. Modifiers from being used
D. Reimbursement for radiology
Answer: B
Rationale: NCCI edits ensure services not separately payable aren’t billed
together.
10. What is the first step in coding?
A. Assign the code
B. Verify reimbursement
C. Review the documentation
D. Query the provider
Answer: C
Rationale: Coding begins with complete review of clinical documentation.
EXAMINATION QUESTIONS AND
CORRECT ANSWERS (VERIFIED
ANSWERS) PLUS RATIONALES 2026 Q&A
| INSTANT DOWNLOAD PDF
1. What is the purpose of ICD-10-CM?
A. To report hospital reimbursement rates
B. To classify diagnoses and reasons for encounters
C. To report inpatient procedures
D. To identify supply charges
Answer: B
Rationale: ICD-10-CM is strictly for reporting diagnoses and encounter reasons,
not procedures or supplies.
2. What is CPT used for?
A. Classifying diseases
B. Tracking mortality
C. Reporting outpatient procedures and services
D. Reporting inpatient procedures
Answer: C
Rationale: CPT codes describe medical, surgical, and diagnostic outpatient
services.
3. HCPCS Level II codes primarily report:
A. Physician services
B. Surgical approaches
,C. Supplies, DME, and drugs
D. Pathology services
Answer: C
Rationale: HCPCS Level II covers non-physician items such as supplies and drugs.
4. Modifier 25 indicates:
A. Significant surgical procedure
B. Reduced services
C. Significant, separately identifiable E/M service
D. Two surgeons
Answer: C
Rationale: Modifier 25 adds clarity that an E/M service was unrelated to a
same-day procedure.
5. Which entity maintains CPT?
A. CMS
B. WHO
C. AMA
D. CDC
Answer: C
Rationale: The American Medical Association owns and maintains CPT.
6. “Established patient” means the patient was seen within:
A. 2 years
B. 1 year
C. 3 years
D. 5 years
Answer: C
Rationale: CPT defines established patients as those seen by the provider/group
within 3 years.
7. What is upcoding?
, A. Adding modifiers incorrectly
B. Coding higher than documentation supports
C. Omitting codes
D. Billing multiple providers
Answer: B
Rationale: Upcoding results in inappropriate higher reimbursement.
8. A global surgical package includes:
A. New unrelated visits
B. Only the surgery
C. Preoperative, intraoperative, and routine postoperative care
D. Lab tests
Answer: C
Rationale: The global period includes routine care before and after surgery.
9. An NCCI edit prevents:
A. E/M reporting
B. Billing two services that shouldn’t be paid together
C. Modifiers from being used
D. Reimbursement for radiology
Answer: B
Rationale: NCCI edits ensure services not separately payable aren’t billed
together.
10. What is the first step in coding?
A. Assign the code
B. Verify reimbursement
C. Review the documentation
D. Query the provider
Answer: C
Rationale: Coding begins with complete review of clinical documentation.
