3 2 1 Code It Exam 1 Practice Guide

3 2 1 CODE IT EXAM 1

PRACTICE GUIDE

Question 1: What is the primary purpose of assigning a diagnostic code?

Choices:

1) To track physician working hours 2) To establish medical necessity for the procedures provided 3) To determine the patient's insurance premium 4) To register the patient at the front desk

Correct Answer: To establish medical necessity for the procedures provided

Explanation: Diagnostic codes communicate the medical necessity of procedures and services to third-party payers.Page 1

Question 2: Which coding system is primarily used to report diagnoses?

Choices:

1) CPT

2) HCPCS Level II

3) ICD-10-CM

4) CDT

Correct Answer: ICD-10-CM

Explanation: ICD-10-CM (International Classi�cation of Diseases, 10th Revision, Clinical Modi�cation) is used to code diagnoses.

Question 3: Which organization publishes and maintains the CPT code set?

Choices:

1) World Health Organization (WHO) 2) Centers for Medicare & Medicaid Services (CMS) 3) American Medical Association (AMA) 4) American Health Information Management Association (AHIMA)

Correct Answer: American Medical Association (AMA)

Explanation: The American Medical Association (AMA) holds the copyright to and maintains the Current Procedural Terminology (CPT) code set.Page 2

Question 4: When a provider queries a patient's insurance company prior to a

procedure to con�rm it is covered, this is known as:

Choices:

1) Preauthorization 2) Reimbursement 3) Adjudication 4) Coordination of Bene�ts

Correct Answer: Preauthorization

Explanation: Preauthorization is the process of obtaining prior approval as to the appropriateness of a service or medication.

Question 5: What does a medical coder use a 'physician query' for?

Choices:

1) To bill the patient directly for unpaid balances 2) To schedule the patient's next appointment 3) To request clari�cation about documentation and the codes to be assigned 4) To report fraudulent activity to the OIG Correct Answer: To request clari�cation about documentation and the codes to be assigned Explanation: Coders use a query process to contact the responsible physician to request clari�cation about ambiguous or incomplete documentation.Page 3