AAMA Medical Coding and Billing 3 — Questions and Answers
Question 1: Which HCPCS Level II code category is used for durable medical equipment (DME)?
- E codes (Correct answer)
- A codes
- L codes
- G codes
Correct answer: E codes
HCPCS Level II E codes are assigned to durable medical equipment such as wheelchairs, walkers, and hospital beds.
Question 2: A claim is submitted with an incorrect patient date of birth, causing a denial. This is an example of which type of billing error?
- Demographic error (Correct answer)
- Upcoding
- Unbundling
- Duplicate billing
Correct answer: Demographic error
A demographic error involves incorrect patient information such as name, date of birth, or insurance ID that causes a claim denial.
Question 3: What is the global surgical package in CPT coding?
- A bundle of services included in a surgical fee, covering preoperative, intraoperative, and postoperative care (Correct answer)
- A group of unrelated procedures billed together on one claim
- A set of diagnosis codes assigned to a single surgical encounter
- A package of supplies and equipment billed with a procedure
Correct answer: A bundle of services included in a surgical fee, covering preoperative, intraoperative, and postoperative care
The global surgical package bundles all services related to a surgery—pre-op, the procedure itself, and post-op follow-up—into one reimbursement.
Question 4: Which of the following describes 'upcoding'?
- Billing a higher-level service than was actually performed (Correct answer)
- Assigning an incorrect diagnosis code
- Submitting the same claim twice
- Billing for services not covered by insurance
Correct answer: Billing a higher-level service than was actually performed
Upcoding is fraud that involves reporting a higher-level or more complex service than was actually provided to receive greater reimbursement.
Question 5: In the CMS-1500 claim form, Box 21 is used to report:
- Diagnosis codes (Correct answer)
- CPT procedure codes
- National Provider Identifier (NPI)
- Date of service
Correct answer: Diagnosis codes
Box 21 on the CMS-1500 form is where the provider enters up to 12 ICD diagnosis codes that justify the medical necessity of the services billed.
Question 6: A patient covered by both Medicare and Medicaid is known as a:
- Dual eligible (Correct answer)
- Cross-covered patient
- Secondary subscriber
- Coordination patient
Correct answer: Dual eligible
A dual eligible patient qualifies for both Medicare (primary) and Medicaid (secondary), which may cover Medicare cost-sharing amounts.
Question 7: Which modifier indicates that a procedure or service was distinct or independent from other services performed on the same day?
- -59 (Correct answer)
- -25
- -51
- -52
Correct answer: -59
Modifier -59 identifies procedures or services not normally reported together that are distinct and independent from each other on the same day.
AAMA Medical Coding and Billing 3
Which HCPCS Level II code category is used for durable medical equipment (DME)?