Medical Coding Interview Q&A
Q: What is the difference between ICD-10-CM and CPT?
ICD-10-CM: diagnoses — why the patient was seen, what condition they have. CPT (Current Procedural Terminology): procedures — what was done (surgery, office visit, lab test). Both needed for a complete claim.
Q: What is a CPC certification?
Certified Professional Coder from AAPC. Industry standard for outpatient/physician office coding. 100 MCQ exam, open book (CPT/ICD-10/HCPCS manuals allowed). Requires 80% pass rate.
Q: What is the 7th character in ICD-10 fracture codes?
A=initial encounter, D=subsequent encounter, S=sequela. Always assign 7th character — affects reimbursement and treatment tracking.
Quick Reference — Medical Coding
Key Points for Revision
Related Topics
Explore these connected topics to build complete understanding:
Practice Approach
Further Learning
Connect this topic to the broader healthcare ecosystem.
Each tool in this academy is designed to work with others —
understanding the integration points is what separates intermediate from senior practitioners.
Medical Coding Interview Q&A
Q: What is the sequencing rule for principal diagnosis?
The principal diagnosis is the condition established to be chiefly responsible for the admission. In outpatient settings: code the condition to the highest degree of certainty (sign/symptom if diagnosis not confirmed). In inpatient: can code "probable" or "suspected" diagnoses as if established.
Q: What are E/M codes and how are they selected?
Evaluation and Management codes (99202-99499 outpatient, 99221-99233 inpatient). Selected based on: Medical Decision Making (MDM) complexity — Number and complexity of problems, Amount and/or complexity of data reviewed, Risk of complications. Or Total time spent on date of encounter. 2021 AMA guidelines simplified this — time or MDM, not all three key components.
Q: What is Modifier 25 and when is it used?
Modifier 25: Significant, separately identifiable E/M service by the same physician on the same day as a procedure. Used when: patient comes in for a procedure but also receives a separate, medically necessary E/M service on the same visit. Without Modifier 25, payer bundles the E/M into the procedure payment.
Q: What is HIPAA's role in medical coding?
HIPAA mandates standard code sets for electronic transactions: ICD-10-CM/PCS for diagnoses/procedures, CPT/HCPCS for services and supplies. All covered entities must use these standardised codes. HIPAA also governs PHI (Protected Health Information) — coders handle PHI and must follow minimum necessary access, encryption, and breach notification requirements.
Q: What is the difference between ICD-10-CM and ICD-10-PCS?
ICD-10-CM: diagnoses — used in all settings (inpatient, outpatient, physician). ICD-10-PCS: procedures — used ONLY in inpatient hospital settings (inpatient facility billing). CPT codes are used for outpatient and physician procedure coding. PCS codes are 7-character alphanumeric; CM codes are 3-7 character alphanumeric.
This section is part of the SynfraCore learning platform. Use the sidebar to navigate to Overview, Fundamentals, Advanced, and Cheatsheet sections for comprehensive coverage of this topic.