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Quizzes > Quizzes for Business > Healthcare

Medical Billing and Coding Quiz Challenge

Test Your Healthcare Claims and Coding Skills

Difficulty: Moderate
Questions: 20
Learning OutcomesStudy Material
Colorful paper art illustrating a quiz on Medical Billing and Coding.

Jumpstart your career with this Medical Billing and Coding Quiz designed for aspiring coders and billing specialists. This engaging quiz of 15 multiple-choice questions covers ICD-10, CPT, and claims processing to sharpen your skills. Perfect for students and professionals seeking to test coding accuracy, you can explore related challenges like the ICD-10 Medical Coding Knowledge Test or Healthcare Billing Knowledge Quiz . All questions are fully editable in our intuitive editor, making customization a breeze. Ready to advance your healthcare claims expertise? Visit quizzes to find more learning opportunities.

What is the correct format of an ICD-10-CM diagnosis code?
Five numeric digits only
Three letters followed by two numbers
One letter followed by two numbers, a decimal, then up to four characters
Two letters followed by three numbers
ICD-10-CM codes start with one alpha character, followed by two numeric characters, a decimal point, and up to four additional alphanumeric characters. This format allows for greater specificity in diagnosis coding.
Which code set is used to report medical procedures and services on outpatient and office claims?
ICD-10-CM
HCPCS Level II
CPT
NDC
CPT (Current Procedural Terminology) codes are used to report medical, surgical, and diagnostic procedures and services. ICD-10-CM is used for diagnoses, HCPCS Level II for supplies, and NDC for drug identification.
HCPCS Level II codes are primarily used to report which of the following?
Inpatient diagnoses
Durable medical equipment, prosthetics, and supplies
Prescription drug NDC codes
Surgical procedure bundles
HCPCS Level II codes are alphanumeric codes used to report products, supplies, and services not included in CPT, such as durable medical equipment, prosthetics, orthotics, and supplies.
Which claim form is typically used by physicians to submit professional service claims?
UB-04
CMS-1500
837P
837I
The CMS-1500 form is used by non-institutional providers to submit paper claims for professional services. The UB-04 is used for institutional claims, and 837P/I are electronic equivalents.
Under HIPAA compliance, what is the primary purpose of the Privacy Rule?
Regulate billing office hours
Protect patient health information confidentiality
Standardize ICD-10 codes
Set hospital accreditation standards
The HIPAA Privacy Rule sets national standards to protect individuals' medical records and other personal health information. It ensures that patient information is properly safeguarded and only disclosed with proper authorization.
A patient presents with essential (primary) hypertension. Which ICD-10-CM code should be reported?
I11.9
E11.9
I10
I15.0
I10 is the ICD-10-CM code for essential (primary) hypertension without complications. I11.9 is hypertensive heart disease, E11.9 is type 2 diabetes without complications, and I15.0 is secondary hypertension.
A new patient presents for a moderate complexity office visit lasting 30 minutes. Which CPT code is most appropriate?
99203
99202
99212
99213
CPT code 99203 describes a new patient office or other outpatient visit of moderate complexity, usually lasting around 30 minutes. Codes 99212 and 99213 are for established patients.
Which of the following is a valid HCPCS Level II code for a manual wheelchair?
A9270
E1230
K0745
L0625
E1230 is the HCPCS Level II code for a standard manual wheelchair. K-codes are for durable medical equipment rentals, L-codes for orthotic/prosthetic, and A9270 for non-specific DME supplies.
What is the standard timely filing limit for Medicare claims from date of service?
30 days
180 days
90 days
1 year
Medicare generally requires claims to be filed within 12 months (one year) from the date of service. Filing after this period can result in denial for being untimely.
Billing a level 5 E/M service when the documentation supports only a level 3 visit is an example of:
Unbundling
Upcoding
Downcoding
Misclassification
Upcoding refers to reporting a higher-level service than what was documented or performed, often leading to higher reimbursement and potential compliance issues. Downcoding is the opposite.
When should modifier 25 be appended to a CPT code?
To indicate discontinued procedures
To indicate procedure performed during global surgery period
To report a significant, separately identifiable E/M service on the same day as a procedure
To report multiple surgeons
Modifier 25 is used when a separately identifiable evaluation and management service is provided by the same physician on the same day as a procedure or other service. It signals distinct work.
Which service is typically included in a surgical global period?
Anesthesia services
Unrelated E/M visits
Postoperative follow-up visits related to the surgery
Durable medical equipment
The global surgical package includes preoperative, intraoperative, and postoperative services related to the surgery, including routine follow-up visits. Anesthesia and unrelated visits are billed separately.
In ICD-10-CM, which seventh character is used to indicate a subsequent encounter for a fracture?
B (Not applicable)
D (Subsequent encounter)
S (Sequela)
A (Initial encounter)
The seventh character 'D' is used in ICD-10-CM to indicate a subsequent encounter for treatment of a fracture. 'A' is for initial encounters and 'S' for sequela.
What does participating in assignment of benefits allow a provider to do?
Accept the Medicare-approved amount as full payment
Receive payments directly from the patient only
Avoid using NPI numbers
Bill any amount to the patient
When a provider accepts assignment, they agree to be paid the Medicare-approved amount and cannot bill the patient for additional balances. This ensures the provider follows fee schedules.
When two insurance plans cover a patient, the primary payer is determined by:
The plan with the alphabetically first name
The plan with the highest coverage limit
The birthday rule ordering based on dates of birth
Patient's choice
The birthday rule states that the plan of the parent whose birthday falls earlier in the calendar year is primary for a dependent child. This rule helps coordinate benefits correctly.
Which ICD-10-CM code correctly identifies Type 2 diabetes mellitus with diabetic nephropathy?
E11.9
E10.22
E11.65
E11.21
E11.21 is the specific code for Type 2 diabetes mellitus with diabetic nephropathy, combining both the disease and its complication in one code. E11.9 lacks complications.
A provider performs two distinct procedures on the same day: a diagnostic colonoscopy (45378) and a colorectal lesion biopsy (45380). To bypass NCCI edits and report these separately, which modifier is best appended to the biopsy code?
Modifier 24
Modifier 76
Modifier 25
Modifier 59
Modifier 59 indicates a distinct procedural service when procedures are normally bundled but are separate and independent. It allows reporting of both colonoscopy and biopsy.
Hospital outpatient services are reimbursed under which prospective payment system?
APC
CDM
DRG
RBRVS
The Ambulatory Payment Classification (APC) system is used by Medicare to reimburse hospital outpatient services. DRGs are used for inpatient prospective payment.
The National Correct Coding Initiative (NCCI) monitors billing to:
Assign Medicare Advantage plan rates
Audit ICD-10-CM code accuracy
Prevent unbundling of related procedures
Ensure hospitals use UB-04 forms correctly
NCCI edits are designed to prevent improper coding leading to unbundling or fragmentation of services that should be reported together. This helps maintain billing integrity.
Which action would violate the False Claims Act?
Altering diagnostic codes to receive higher reimbursement
Providing a discount to uninsured patients
Using cleared claim submission software
Documenting medical necessity in the chart
Falsifying or altering codes to obtain higher payments constitutes a false claim under federal law. Accurate coding and documentation are required to avoid legal and compliance issues.
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Learning Outcomes

  1. Analyze common ICD-10 codes for accurate billing
  2. Evaluate appropriate CPT coding scenarios
  3. Master claim submission protocols and guidelines
  4. Identify billing errors and compliance issues
  5. Demonstrate understanding of HCPCS Level II codes
  6. Apply best practices in healthcare claims processing

Cheat Sheet

  1. Master the ICD-10-CM Coding Guidelines - Dive into the official rules to make sure every diagnosis is coded with pinpoint accuracy and the full complement of characters, including those tricky 7th characters. Think of it like unlocking cheat codes in a video game - each extra character levels up your claim's precision. CMS ICD-10-CM Coding Guidelines
  2. Understand the Structure of ICD-10-PCS Codes - Break down the seven-part alphanumeric puzzle so each character reveals a piece of the procedure story, from the body system to the exact operation performed. It's like reading a secret map where every symbol guides you to the treasure of accurate coding. ICD-10-PCS Structure
  3. Differentiate Between CPT and HCPCS Level II Codes - CPT codes capture clinical services and medical procedures, while HCPCS Level II steps in for supplies and equipment, like wheelchairs or prosthetics. Knowing which code set to choose is as crucial as picking the right tool for a DIY project - get the match wrong, and your claim falls apart. CPT vs HCPCS Comparison
  4. Apply the 'Medical Necessity' Principle in Coding - Always align your chosen codes with the patient's condition to demonstrate that each service was essential, not just optional. Picture yourself as a detective gathering evidence: the stronger your documentation, the smoother your claims glide through approval. Medical Necessity Guide
  5. Recognize Common Billing Errors to Avoid Claim Denials - From typos in patient data to mismatched codes or missing signatures, little mistakes can trigger big denials. Think of regular audits as your secret weapon - spotting and fixing errors early keeps your revenue cycle on track. Top Billing Errors
  6. Stay Updated with Annual Code Set Changes - Codebooks evolve every year with new entries and tweaks, so staying current is like keeping your phone's software up-to-date - essential for peak performance. Make a habit of reviewing update summaries to avoid coding blind spots. Annual Code Updates
  7. Utilize Modifiers Correctly in CPT Coding - Modifiers are the spice that adds flavor to a base code, indicating extras like multiple procedures or altered services. Misplacing a modifier is like adding salt instead of sugar - suddenly the whole dish (or claim) tastes off. Guide to CPT Modifiers
  8. Understand the Importance of Documentation in Coding - Clear, thorough notes justify every code and defend your work in audits or appeals. Think of your clinical documentation as a storyboard: the more detailed, the more convincing the narrative. Documentation Best Practices
  9. Learn the Process of Claim Submission and Follow-Up - Master each step from patient verification to code entry and then monitor your claim's journey to payment. Following up is like tracking a pizza delivery - stay on top of it and you'll know exactly when it arrives. Claim Submission Steps
  10. Adhere to HIPAA Regulations in Medical Billing - Protect patient privacy by following HIPAA's rules for handling sensitive health information, because confidentiality is non-negotiable. Consider it the gold standard handshake that builds trust with patients and payers alike. HIPAA Compliance Essentials
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