CCA Compliance & Ethical Coding Practice Questions
Compliance & Ethical Coding makes up 7 of every 50 questions on a Tigertest CCA practice test. Here are 10 of the 28 questions on it, each with the answer and the reason.
Updated by the Tigertest team. Weighted to the AHIMA CCA Exam Content Outline. Original questions on coding guidelines and concepts; not affiliated with AHIMA.
1. A diagnosis on the problem list was not addressed by the provider at this visit. The coder should:
- A.Code it if it is chronic
- B.Not code it from the list
- C.Code it as secondary
- D.Code it as primary
Answer: B. Codes are assigned from the provider's documentation of the encounter. A problem list entry alone does not show the condition was evaluated or treated.
2. Assigning a code for a more severe condition than the record supports, to raise payment, is:
- A.Downcoding
- B.Resequencing
- C.Unbundling
- D.Upcoding
Answer: D. Upcoding reports a higher level or more serious condition than documented. AHIMA's Standards of Ethical Coding forbid it.
3. The code a physician checked on an encounter form does not match the visit note. The coder should:
- A.Follow the note and clarify
- B.Drop the service line
- C.Use the physician's code
- D.Pick the higher-level code
Answer: A. Codes must be supported by the documentation, so the coder works from the note and raises the mismatch with the physician.
4. The discharge summary lists acute respiratory failure, but no progress note mentions or treats it. The best action is to:
- A.Drop it without asking
- B.Code it as a symptom
- C.Query the attending
- D.Code it as written
Answer: C. A diagnosis that conflicts with the rest of the record is a discrepancy to resolve with a compliant query, not to code or drop on the coder's own judgment.
5. Under AHIMA's Standards of Ethical Coding, a coder told by a manager to add an unsupported diagnosis should:
- A.Add it with a note
- B.Code it as uncertain
- C.Refuse to code it
- D.Add it as instructed
Answer: C. Coders report only what the record supports and must not change codes to misrepresent care. Concerns go to the compliance officer.
6. A compliant physician query must be:
- A.Non-leading
- B.Focused on payment
- C.Written by billing staff
- D.Verbal only
Answer: A. The AHIMA/ACDIS query guidelines require queries that do not lead the provider to a particular answer. They present the clinical facts and let the provider decide.
7. A compliant multiple choice query should list clinically reasonable options and:
- A.Only options the coder favors
- B.A pre-selected likely answer
- C.The code for each option
- D.Other and unable to determine
Answer: D. Multiple choice queries include clinically reasonable options plus other and unable to determine (or similar), so the provider is never pushed toward one answer.
8. Per the compliant query practice guidelines, a yes/no query may be used to:
- A.Choose between diagnoses
- B.Establish POA status
- C.Add a new diagnosis
- D.Raise severity of illness
Answer: B. Yes/no queries are limited to uses such as present on admission status, cause and effect, or conflicting documentation. They must never introduce a new diagnosis.
9. A compliant physician query must never:
- A.Offer an other option
- B.Mention financial impact
- C.Include clinical indicators
- D.Be made in writing
Answer: B. Queries cite clinical indicators from the record and must not mention payment, DRG or quality score effects, which could sway the answer.
10. A hospital's chargemaster (CDM) is its:
- A.Coding policy manual
- B.Payer contract file
- C.Master patient index
- D.List of billable items and charges
Answer: D. The chargemaster lists each billable service and supply with its charge, CPT or HCPCS code, revenue code and department.
Practice all 28 compliance & ethical coding questions, and the rest of the 200-question bank, in the free CCA training sets. Questions you miss come back until you have mastered them.
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