Sample CPC Or CCS Questions And Answers

Here are some sample CPC (Certified Professional Coder) or CCS (Certified Coding Specialist) questions and answers:

1. Which of the following is an example of a “downcoding” issue?

1. A physician bills for a level 4 office visit, but the documentation supports only a level 3 visit.
2. A physician bills for a level 3 office visit, but the documentation supports a level 4 visit.
3. A physician bills for a level 5 office visit, but the documentation supports only a level 2 visit.
4. A physician bills for a level 2 office visit, but the documentation supports a level 5 visit.

Answer: A. A “downcoding” issue occurs when a physician bills for a higher level of service than the documentation supports. In this example, the physician billed for a level 4 office visit, but the documentation only supports a level 3 visit.

1. What is the ICD-10 code for a patient with a history of breast cancer who is receiving chemotherapy?

85. Z85.3
86. C50.919
87. Z51.11
88. Z51.12

Answer: B. The ICD-10 code for breast cancer is C50, and the code for chemotherapy is 919. Therefore, the correct code for a patient with a history of breast cancer who is receiving chemotherapy is C50.919.

1. What is the correct CPT code for a diagnostic mammogram of the left breast?

1. 77067
2. 77056
3. 77057
4. 77055

Answer: C. The CPT code for a diagnostic mammogram of one breast is 77057.

1. Which of the following is an example of an “unbundling” issue?

1. A physician bills for a complete blood count (CBC) and a hemoglobin A1c test separately, even though the CBC includes the hemoglobin A1c test.
2. A physician bills for a chest x-ray and a chest CT scan separately, even though the CT scan was performed to confirm a finding on the x-ray.
3. A physician bills for a level 4 office visit and a flu shot separately, even though the flu shot is included in the office visit.
4. A physician bills for a surgical procedure and the anesthesia separately, even though the anesthesia is an integral part of the surgical procedure.

Answer: A. “Unbundling” occurs when separate codes are billed for services that are included in another code. In this example, the physician billed separately for a CBC and a hemoglobin A1c test, even though the CBC includes the hemoglobin A1c test.

1. What is the ICD-10 code for a patient with diabetes who is taking insulin?

10. E10.9
11. E11.9
12. Z79.4
13. Z79.84

Answer: B. The ICD-10 code for diabetes is E10 or E11, depending on the type of diabetes. The code for a patient taking insulin is 9, so the correct code for a patient with diabetes who is taking insulin is E11.9.