certified procedural coder Interview Questions and Answers

1. What is procedural coding?

   • Answer: Procedural coding is a system of assigning codes to describe the procedures and services performed during a medical encounter. It's based on the individual actions taken by the healthcare provider, rather than the diagnosis itself. These codes are used for billing and reimbursement purposes.

2. Explain the difference between CPT and HCPCS codes.

   • Answer: CPT (Current Procedural Terminology) codes are maintained by the American Medical Association (AMA) and describe medical, surgical, and diagnostic services. HCPCS (Healthcare Common Procedure Coding System) codes are a broader system that includes CPT codes, as well as codes for supplies, devices, and other services not covered by CPT. Level I HCPCS codes are CPT codes; Level II are national codes for items and services not included in CPT.

3. What are modifiers and how are they used?

   • Answer: Modifiers are two-digit alphanumeric codes appended to CPT and HCPCS codes to provide additional information about the service performed. They clarify circumstances surrounding the procedure, such as the location of the service (e.g., 26 – professional component, TC – technical component), the type of anesthesia used, or multiple procedures performed.

4. Describe the process of selecting the correct CPT code.

   • Answer: Selecting the correct CPT code requires careful review of the documentation, including the physician's notes, operative reports, and other relevant medical records. The coder must identify the specific procedure performed, the extent of the procedure, and any modifiers that apply. This often involves using the CPT manual's index and tabular lists to pinpoint the most accurate code.

5. What resources do you use to stay current with CPT and HCPCS code updates?

   • Answer: I stay up-to-date through subscriptions to official publications from the AMA (for CPT) and CMS (for HCPCS), online resources, continuing education courses, and professional networking within the coding community.

6. How do you handle unlisted procedures?

   • Answer: Unlisted procedures require careful documentation and justification. I would thoroughly review the medical record to determine the exact procedure performed. Then, I would follow the guidelines for reporting unlisted procedures, which typically involve submitting a detailed report explaining the procedure and justifying the use of an unlisted code (e.g., CPT code 00000) to the payer.

7. Explain the importance of proper documentation for accurate coding.

   • Answer: Proper documentation is crucial for accurate coding because the codes must reflect the services actually rendered. Incomplete or unclear documentation can lead to inaccurate coding, resulting in denied claims, delayed payments, and potential legal issues. The documentation must support the code selected.

8. What is medical necessity and why is it important in coding?

   • Answer: Medical necessity refers to the appropriateness of a service based on the patient's diagnosis, symptoms, and medical condition. It's essential for coding because payers only reimburse for services deemed medically necessary. Codes for unnecessary services will likely be denied.

9. Describe your experience with electronic health records (EHRs) and their impact on coding.

   • Answer: [Insert your specific experience with EHRs. This should include specific software used, familiarity with different EHR systems, and how you navigate the system to extract information for coding purposes. Discuss how EHRs have improved or challenged the coding process.]

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