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Quizzes > Health & Medicine > Human Anatomy & Medicine

Take the Medical Billing & Coding Practice Test

Think you can ace this billing and coding practice exam? Start now!

Difficulty: Moderate
2-5mins
Learning OutcomesCheat Sheet
Paper art illustration of medical billing and coding quiz icons on sky blue background

Use this medical billing and coding practice test to build and check your skills on CPT, ICD‑10, claim forms, and clean claim rules. Answer case‑based items to spot gaps before the exam. Want focused coding drills next? Try our coding-only quiz .

What is the required structure of a valid ICD-10-CM diagnosis code?
Three alphabetic characters only
A numeric character followed by three alphabetic characters
Two numeric characters followed by two alphabetic characters
One alpha character, two numeric characters, then a decimal and up to four alphanumeric characters
ICD-10-CM codes consist of 3 to 7 characters: the first position is a letter, the next two are numbers, then a decimal point followed by up to four alphanumeric characters for specificity. This allows more detailed classification compared to ICD-9. Understanding the structure is essential for accurate coding.
Which form is used to submit professional outpatient claims to payers?
UB-04
CMS-1500
CMS-1450
ADA Dental Claim Form
The CMS-1500 form (also known as HCFA 1500) is the standard claim form used by non-institutional providers to bill professional services, including physician services and outpatient procedures. The UB-04 (CMS-1450) is used by institutional providers like hospitals. Proper form usage ensures timely reimbursement.
CPT codes are maintained and published by which organization?
American Medical Association
Centers for Medicare & Medicaid Services
World Health Organization
American Hospital Association
The American Medical Association (AMA) is responsible for developing, updating, and maintaining CPT codes, which are used to describe medical, surgical, and diagnostic services. These codes ensure uniform communication among providers, insurers, and accreditation organizations.
What is the primary purpose of a HCPCS Level II code?
To code inpatient hospital procedures
To describe molecular pathology procedures
To identify specific diagnoses
To report durable medical equipment, prosthetics, and supplies
HCPCS Level II codes cover products, supplies, and services not included in CPT, such as durable medical equipment, prosthetics, orthotics, and ambulance services. CPT codes (HCPCS Level I) cover most medical services and procedures. Using the correct code set ensures accurate billing for non-physician services.
True or False: A National Provider Identifier (NPI) is required for electronic claims submission in the U.S.
False
True
The NPI is a unique 10-digit identification number required for all healthcare providers when submitting electronic health transactions, including claims. It standardizes provider identification across all HIPAA-covered entities. Failure to include an NPI can result in claim rejection.
Which modifier should be appended to a CPT code to indicate a significant, separately identifiable E/M service performed on the same day as a procedure?
24
25
51
59
Modifier 25 is used to report a significant, separately identifiable Evaluation and Management service by the same physician on the same day as another procedure. Modifier 59 indicates a distinct procedural service, while 24 and 51 are used for unrelated E/M services and multiple procedures respectively. Proper use avoids claim denials.
What does the acronym NCCI stand for in medical coding?
National Compliance Coding Index
National Certified Coding Instructor
National Correct Coding Initiative
National Clinical Coding Institute
The National Correct Coding Initiative (NCCI) was implemented by CMS to promote national correct coding methodologies and to control improper coding leading to overpayments. The NCCI edits pair correct CPT/HCPCS codes to reduce unbundling and ensure appropriate billing.
Which of the following is NOT one of the three key components used to select the level of E/M service?
Medical decision making
Referring provider
Physical examination
History
E/M services are selected based on three key components: history, physical examination, and medical decision making. The referring provider is not a component of E/M level selection. Accurate application of these components is essential for compliant coding.
What is the main purpose of Diagnosis-Related Groups (DRGs) in the inpatient setting?
To list physician specialty revenue codes
To group outpatient surgical procedures
To identify medical necessity for DME
To classify inpatient hospital stays for prospective payment
DRGs are used by Medicare and many insurers to classify hospital inpatient stays into groups for payment purposes. Each DRG has a fixed rate, encouraging hospitals to manage costs efficiently. DRGs do not apply to outpatient services or physician billing.
HCPCS Level I codes are more commonly known as which of the following?
CPT codes
Revenue codes
HCPCS Level II codes
ICD-10-CM codes
HCPCS Level I codes refer to the CPT code set maintained by the AMA, and they cover services and procedures. Level II codes are alphanumeric and cover DME, supplies, and non-physician services. Distinguishing between Level I and II is crucial for correct billing.
Which characteristic is unique to ICD-10-PCS procedure codes compared to ICD-10-CM diagnosis codes?
They can be 3 to 7 characters long
They always contain exactly seven alphanumeric characters without a decimal point
They begin with a letter followed by two digits
They use a decimal after the third character
ICD-10-PCS codes are used for inpatient procedures and consist of seven alphanumeric characters without a decimal point; each character represents a specific axis of the procedure. In contrast, ICD-10-CM diagnosis codes are 3 to 7 characters with a decimal after the third character. Understanding this distinction is vital for accurate facility billing.
In the hospital revenue cycle, which step directly follows claim submission and precedes payment posting?
Claims adjudication
Patient registration
Appeals
Charge capture
After claims are submitted, payers perform claims adjudication, which is the process of reviewing, approving, or denying claims. Once adjudication is complete, payments are posted to the provider's account. Accurate tracking of this step is key to managing accounts receivable.
What is the primary purpose of an Explanation of Benefits (EOB) document?
To detail how a claim was processed, including patient responsibility
To assign initial diagnosis codes
To record inpatient procedure details
To submit authorization requests
An EOB is provided by the payer after processing a claim to explain payments, adjustments, and what portion, if any, the patient owes. It ensures transparency for providers and patients regarding coverage decisions. It is not used to assign codes or request authorizations.
Which component is NOT included in the calculation of the Medicare Physician Fee Schedule for individual services?
Relative value units (RVUs)
Geographic Practice Cost Indices (GPCIs)
Conversion factor
Global period
The Medicare Physician Fee Schedule is calculated by multiplying RVUs by GPCIs and then by a conversion factor. The global period describes the postoperative time bundled into service fees and is not part of the core fee schedule calculation. Knowing these elements helps in accurate fee determination.
Which document published by the Office of Inspector General (OIG) outlines annual priorities for auditing coding compliance and improper payments?
OIG Work Plan
NCCI Policy Manual
HIPAA Security Rule
False Claims Act
The OIG Work Plan is released annually and details the Office of Inspector General's priority areas for audits, evaluations, and inspections, including coding compliance and improper payment risks. It guides providers and auditors in identifying high-risk areas. Staying current with the OIG Work Plan supports proactive compliance efforts.
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Study Outcomes

  1. Apply coding guidelines -

    Use official CPT, ICD-10-CM, and HCPCS codes accurately in billing scenarios to reflect patient procedures and diagnoses.

  2. Identify common billing errors -

    Spot discrepancies in case studies and correct coding mistakes to reduce claim denials and ensure compliance.

  3. Interpret procedure and diagnosis codes -

    Analyze sample medical records to match appropriate codes with documented treatments and conditions.

  4. Evaluate reimbursement requirements -

    Assess payer guidelines and documentation standards to optimize claim submissions and secure timely payment.

  5. Demonstrate coding efficiency -

    Complete timed practice questions to enhance accuracy and speed in real-world billing and coding tasks.

  6. Analyze test performance -

    Review quiz results to pinpoint strengths and weaknesses and create a targeted study plan for certification success.

Cheat Sheet

  1. ICD-10-CM vs. CPT Code Structure -

    ICD-10-CM codes classify diagnoses with a three-to-seven character alphanumeric format, while CPT codes use five numeric digits for procedures. For example, E11.9 designates Type 2 diabetes mellitus without complications and 99213 indicates an established patient office visit. Mnemonic trick: "ICD-TEN has letters, CPT is all digits!"

  2. Accurate Documentation & Compliance -

    Strong documentation under HIPAA and CMS guidelines is critical to demonstrate medical necessity and avoid denials on a medical billing and coding practice test. Always cross-reference physician notes with ICD-10-CM and CPT code definitions to ensure specificity. AU of thumb: "If it's not in the chart, it didn't happen."

  3. Modifiers and Bundling Rules -

    Mastering NCCI edits and modifier usage - like appending -25 for a significant, separately identifiable E/M service - helps you tackle complex scenarios on a billing and coding practice exam. Remember that unbundling bundled services is prohibited and can trigger audits. Think "Modifier makes it matter!" to recall the extra element.

  4. Claim Forms & Electronic Submission -

    Know the CMS-1500 and UB-04 forms inside out and practice completing them accurately for a medical billing coding test. Electronic claims use ANSI X12 837 format, reducing errors and speeding reimbursement. Pro tip: validate field entries with free CMS companion guides before submission.

  5. Reimbursement Methodologies -

    Familiarize yourself with RVUs, the Medicare Physician Fee Schedule, and DRG assignments to predict payment outcomes on a medical billing practice exam. RVU = Work RVU + Practice Expense RVU + Malpractice RVU, then multiplied by the conversion factor. Use the formula "Total RVU × CF = Medicare payment" as a quick reference.

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