certified medical coding specialist Interview Questions and Answers

1. What is medical coding?

   • Answer: Medical coding is the process of transforming medical diagnoses, procedures, and services into standardized alphanumeric codes used for billing, reimbursement, and data analysis. It involves using coding systems like ICD-10-CM for diagnoses and CPT/HCPCS for procedures.

2. Explain the difference between ICD-10-CM and ICD-10-PCS.

   • Answer: ICD-10-CM (Clinical Modification) classifies diseases and diagnoses, while ICD-10-PCS (Procedure Coding System) classifies medical and surgical procedures. ICD-10-CM is used in the US for diagnoses reported on claims, while ICD-10-PCS is primarily used in inpatient hospital settings.

3. What are CPT codes?

   • Answer: CPT (Current Procedural Terminology) codes are a set of medical codes used to describe medical, surgical, and diagnostic services provided to patients. They are maintained by the American Medical Association (AMA).

4. What are HCPCS codes?

   • Answer: HCPCS (Healthcare Common Procedure Coding System) codes expand on CPT codes and include codes for supplies, equipment, and services not included in CPT. Level I HCPCS codes are the same as CPT codes. Level II codes are alphanumeric and cover items and services not listed in CPT.

5. Describe the importance of medical coding accuracy.

   • Answer: Accurate medical coding is crucial for proper reimbursement, accurate tracking of healthcare data for research and public health purposes, and ensuring providers receive appropriate payment for their services. Inaccuracies can lead to underpayment or denial of claims.

6. What are the key components of a medical claim?

   • Answer: Key components include patient demographics, provider information, diagnosis codes (ICD-10-CM), procedure codes (CPT/HCPCS), dates of service, and place of service.

7. Explain the concept of medical necessity.

   • Answer: Medical necessity refers to whether a service or procedure is appropriate and necessary for the diagnosis or treatment of a patient's condition, according to accepted standards of medical practice.

8. What is the role of an encoder in medical coding?

   • Answer: An encoder assists in the selection of appropriate medical codes by using a software program that analyzes clinical documentation and suggests codes based on the information provided.

9. What is the difference between outpatient and inpatient coding?

   • Answer: Outpatient coding focuses on services provided in non-hospital settings (physician offices, clinics), using CPT/HCPCS and ICD-10-CM. Inpatient coding involves hospital stays, utilizing ICD-10-CM and ICD-10-PCS.

10. What are some common compliance issues in medical coding?

    • Answer: Upcoding (assigning codes for higher reimbursement than appropriate), downcoding (assigning codes for lower reimbursement), unbundling (billing individual components of a procedure separately when bundled coding is appropriate), and lack of medical necessity documentation are common compliance issues.

11. Explain the process of auditing medical codes.

    • Answer: Auditing involves reviewing medical records and comparing the coded information to the documentation to ensure accuracy and compliance with coding guidelines and regulations. This may involve random sampling or focused audits on specific areas.

12. What are some resources you use to stay updated on coding changes?

    • Answer: Staying current involves using resources like the AMA website for CPT updates, CMS for ICD-10 updates, professional coding textbooks and journals, continuing education courses, and professional coding associations.

13. How do you handle ambiguous or unclear documentation?

    • Answer: When documentation is unclear, I would query the physician or provider for clarification to ensure accurate coding. I would document the query and the response received.

14. Describe your experience with Electronic Health Records (EHR) systems.

    • Answer: [This answer should be tailored to the individual's experience. Example: "I have extensive experience with Epic and Cerner EHR systems, proficiently navigating them to extract relevant coding information."]

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