2026 FINAL EXAMFOR Certified Professional Coder and Biller (CPC®) 70 POSSIBLE QUESTIONS AND ANSWERS

2026 FINAL EXAMFOR Certified Professional Coder and Biller (CPC®) 70 POSSIBLE QUESTIONS AND ANSWERS

Correct Incorrect

Your answers

drug?

generic

2 of 70 Term

The HIPAA Security Rule provides standards for health information maintained or transmitted in what format?

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written

manual

generic

electronic

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3 of 70 Term

The patient with a history of osteopenia was referred for a DXA scan of the axial skeleton. What is the correct CPT code, professional component only?

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77080-26

77083-26

77082-26

77081-26

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4 of 70 Term

Individual states administer the Children's Health Insurance Program (CHIP) with matching funds provided from:

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The federal government

The medical director

The provincial health care systems

State governments

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5 of 70 Term

Using the Table of Drugs and Biologicals in the HCPCS Level II codebook, what is the code for a 10 mg injection of morphine sulfate?

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J2260

J2280

J2290

J2270

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6 of 70 Term

What is usually required after attaining a certification?

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Personal protective equipment (ppe)

Patient centered medical home (pcmh)

Continuing education units (CEUs)

Registered nurses (rns)

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7 of 70 Term

Where are the names, dosages, and reasons for all drugs that a patient currently takes documented in a medical record?

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Office Visit Documentation

Medication List

Surgical History

Psychotherapy Notes

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8 of 70 Term

What is price transparency in healthcare?

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Patients are unaware of any charges until billing.

Patients are informed about what charges to expect.

Healthcare providers set prices without patient input.

Costs are hidden until the service is completed.

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9 of 70 Term

What is a written request to a physician to clarify or complete the information in clinical documentation to ensure accurate health records?

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Medication List

Laboratory Report

Physician query

None, query is the only term

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10 of 70 Term

What is considered mandatory when preparing for a certification exam?

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Ignoring the study guide entirely

Reviewing the certification study guide from cover to cover

Focusing only on practice tests

Skimming the exam topics briefly

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11 of 70 Term

What is the standard, unique health identifier that is mandated by HIPAA for each healthcare provider and used for claims processing,

patient eligibility inquiries, claims inquiries, patient referrals, and generation of remittance advices?

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Drug enforcement administration (dea) number

Master Patient Index (mpi)

National Provider Identifier

Universal Physician Number (upn)

(NPI)

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12 of 70 Term

The patient was referred for a bone scan to check for metastatic disease. Which diagnosis would support medical necessity for this procedure?

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Breast cancer

Prostate cancer

Colon cancer

Liver cancer

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13 of 70

Term

The hand surgeon performed a neuroplasty of the ulnar nerve of the left wrist. What is the correct CPT code?

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64719-LT

64718-lt

64720-lt

64717-lt

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14 of 70 Term

The patient was seen for pre-operative cardiovascular examination prior to undergoing cholecystectomy. What is the correct ICD-10CM code?

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Z01.810

Z02.810

Z00.120

Z01.910

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15 of 70 Term

The federal name for the Title XIX medical assistance program is what?

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Medicaid

Champva

Tricare

Medicare

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16 of 70 Term

What is defined as the amount commonly charged for a particular medical service by providers within a certain geographic area.

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Usual, customary, and reasonable (UCR)

Standardized fee schedule (SFS)

Preferred provider rate (PPR)

Maximum allowable charge (MAC)

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17 of 70 Term

What is the two-way, real time video visit between the patient and the physician at a distant site?

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Referral

Ehr

Telehealth

Patient Portal

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18 of 70 Term

What is the term for an individual who has not reached the age of majority (usually 18) but is no longer under the care and control of parents?

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Emancipated minor

Respondeat superior

Mature minor

Medically emancipated

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19 of 70 Term

What is the amount for which the patient is financially responsible before an insurance policy provides payment?

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Deductible

Documented

Premium

Copay

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20 of 70 Term

Which Medicare program pays for physician services, outpatient care, and durable medical equipment?

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Medicare Part D

Medicare Part C

Medicare Part A

Medicare Part B

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21 of 70 Term

What is the missing word in the following phrase: "If it wasn't ___________, it wasn't done."

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Documented

Authorized

Signed Off

Approved

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22 of 70 Term

What is health insurance issued by private companies?

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Domestic

Commercial

Residential

Religious

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23 of 70 Term

What health plans are designed to put more responsibility on the employee for their healthcare spending?

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Consumer-directed health plans

Traditional fee-for-service plans

High deductible health plans

Cafeteria plans

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24 of 70 Term

What is health information in a digital format that is created and shared by providers across more than one healthcare setting?

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Electronic health record (EHR)

Computerized provider order entry (cpoe)

Personal health record (phr)

Computerized physician order entry (cpoe)

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25 of 70 Term

Following surgery, the patient was provided with below-knee-length surgical stockings. What is the correct HCPCS Level II code?

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A4510

A4530

A4500

A4520

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26 of 70 Term

What is a written order from your primary care provider for you to see a specialist or get certain medical services?

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Referral

Generic

Subjective

Assessment

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27 of 70 Term

What type of claim was never entered into the computer system of the insurance company because it failed to meet specific data requirements?

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Dirty claim

Paper claim

Rejected claim

Clean claim

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28 of 70 Term

What is the form required for all physician services or procedures that might not be covered by the Medicare program?

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Advance Beneficiary Notice (ABN)

Remittance advice (ra)

Medicare Summary Notice (msn)

Notice of privacy practices (npp)

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29 of 70 Term

What is the fastest but also most dangerous route of drug administration?

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Subcutaneous

Intravenous

Oral

Sublingual

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30 of 70 Term

Because CMS has a financial incentive to ensure coding accuracy, what did they create to reduce inappropriate payments of Medicare Part B claims?

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Healthcare Billing Accuracy Initiative (HBAI)

National Correct Coding Initiative (NCCI)

Federal Medical Coding Oversight (FMCO)

Medicare Coding Compliance Program (MCCP)

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31 of 70 Term

What type of coverage can Medicare beneficiaries obtain to help with the costs not reimbursed by their Original Medicare plan?

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Tricare

Drgs

Champva

Medigap

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32 of 70 Term

What is the fraudulent coding practice of deliberately submitting multiple CPT codes when just one code should have been submitted?

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Downcoding

Overcoding

Unbundling

Optimizing

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33 of 70 Term

The patient was seen in the outpatient physical therapy department for 15 minutes of ultrasound therapy for bursitis of the hip. What is the correct CPT code?

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97036

97034

97035

97033

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34 of 70 Term

The surgeon amputated the patient's right lower extremity. His physician assistant (PA) actively assisted the surgeon in this surgical procedure. What is the correct HCPCS Level II modifier used for the PA's role in this procedure?

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R07.89

AS

National Provider Identifier (NPI)

E0561

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35 of 70 Term

What type of health insurance is provided through your employer or purchased directly from an insurance company?

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Religious

Commercial

Institutional

Domestic

Don't know?

36 of 70

to patients?

Skipped

Correct answer Place of service

37 of 70 Term

Which of the following is one reason why clinical documentation improvement (CDI) efforts are necessary?

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Skipped

Correct answer It provides an opportunity for physicians to demonstrate the quality of care that was provided.

38 of 70 Term

The durable medical equipment dealer supplied the patient with a non-heated humidifier to be used with his CPAP device. What is the

correct HCPCS Level II code?

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Skipped

Correct answer E0561

39 of 70 Term

The surgeon performed debridement of an open leg wound. Two days later, the surgeon performed a more extensive debridement of the same wound. What modifier is reported with the second service?

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Skipped

Correct answer 58

40 of 70 Term

Where are BCBS claims submitted for processing?

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Skipped

Correct answer The local BCBS plan where the services were provided

41 of 70 Term

Which of the following is an example of an "out-of-pocket" cost?

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Skipped

Correct answer

Deductible

42 of 70 Term

In which main section of the CPT codebook would you find the code for a cholecystectomy?

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Skipped

Correct answer Surgery

43 of 70 Term

What is the maximum amount that an insurer will reimburse for a covered service or procedure?

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Skipped

Correct answer Allowable charge

44 of 70 Term

The patient requested removal of 20 skin tags. What is/are the correct CPT code(s)?

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Skipped

Correct answer 11200, 11201

45 of 70 Term

Which of the following is true concerning the release of patient information?

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Skipped

Correct answer Original records should never be released.

46 of 70 Term

Which of the following is an example of consent?

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Skipped

Correct answer The patient allows insurance benefits to be paid directly to the provider.

47 of 70 Term

Medicare beneficiaries who are referred to as dual eligibles are entitled to which of the following?

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Skipped

Correct answer Medicare and Medicaid

48 of 70 Term

What is the reimbursement method where one payment covers all services during an episode of care?

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Skipped

Correct answer Bundled payment

49 of 70 Term

Which of the following is always the payer of last resort when the patient has multiple third-party payer coverage?

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Skipped

Correct answer Medicaid

50 of 70 Term

For a certification exam, where can you find the eligibility requirements and exam specifications?

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Skipped

Correct answer

The organization's website

51 of 70 Term

Which of the following was created to protect employees against injuries from hazards in the workplace?

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Skipped

Correct answer OSHA

52 of 70 Term

What is the term for two or more physicians who share space, equipment, supplies, and personnel and may represent a single specialty or multiple specialties?

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Skipped

Correct answer Group practice

53 of 70 Term

What is the "main term" for primary pancreatic neoplasm of the head of the pancreas?

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Skipped

Correct answer Neoplasm

54 of 70 Term

What does the HCPCS Level II coding classification system provide to medical providers and suppliers?

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Skipped

Correct answer Codes for reporting procedures, services, medical equipment, and supplies not included in CPT.

55 of 70 Term

The patient's diagnosis is idiopathic scoliosis of the cervicothoracic region. What is the correct ICD-10-CM code?

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Skipped

Correct answer M41.23

56 of 70

Term

What is the computer-to-computer transfer of data between providers and third-party payers?

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Skipped

Correct answer Electronic data interchange (EDI)

57 of 70 Term

Which of the following is an example of fraud?

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Skipped

Correct answer Falsifying patient records to justify the medical necessity of services.

58 of 70 Term

The ICD-10-CM code book is updated annually on what date?

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Skipped

Correct answer October 1

59 of 70 Term

What section of the SOAP note contains the chief complaint and the patient's description of the presenting problem?

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Skipped

Correct answer

Subjective

60 of 70 Term

What is the process of reporting diagnoses and procedures/services as numeric and alphanumeric characters on the insurance claim?

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Skipped

Correct answer Medical coding

61 of 70 Term

In a physician practice, revenue cycle management is also called what?

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Skipped

Correct answer Accounts receivable

62 of 70 Term

What is any information that can link a specific individual to medical records?

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Skipped

Correct answer Protected Health Information (PHI)

63 of 70 Term

What are the private companies that are assigned jurisdictions and serve as the primary contact between the Original Medicare program and participating providers?

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Skipped

Correct answer Medicare Administrative Contractors (MACs)

64 of 70 Term

Which of the following is a reason for why the field of medical billing and coding is in high demand?

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Skipped

Correct answer An aging population will use more healthcare services to manage a multitude of chronic diseases.

65 of 70 Term

A test that screens for antibodies in the blood would be reported on what medical report?

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Skipped

Correct answer Laboratory Report

66 of 70 Term

A five-year-old was brought to the emergency department after falling from a climbing wall and sustaining scrapes and bruises. No sutures were required. The visit involved an expanded problemfocused history and physical exam with decision making of moderate complexity. What is the correct CPT code?

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Skipped

Correct answer

99283

67 of 70 Term

What is a review by BCBS that grants prior approval for reimbursement of a healthcare service?

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Skipped

Correct answer Preauthorization

68 of 70 Term

The patient was seen in follow-up for hypertension and chronic kidney disease, stage 5. What is/are the correct ICD-10-CM code(s)?

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Skipped

Correct answer I12.0 N18.5

69 of 70 Term

The patient was evaluated in the emergency room for anterior chest wall pain, suspected unstable angina. What is the correct ICD-10-CM code?

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Skipped

Correct answer R07.89

70 of 70 Term

Which of the following allows employees to continue healthcare coverage beyond the benefit termination date?