CCC CCC Reimbursement & Payer Policies 2

Question 1

Which payer policy concept prevents a cardiologist from billing for the same service under both the professional and technical component when only the professional portion was provided?

Accepted Answer

Component billing restrictions

Answer

Component billing rules require that only the component actually performed (professional or technical) be billed separately when the full service is not provided by the same entity.

Question 2

What is the purpose of the National Correct Coding Initiative (NCCI) edits in cardiology billing?

Accepted Answer

To prevent improper billing of code pairs that should not be billed together

Answer

NCCI edits identify pairs of CPT codes that Medicare considers mutually exclusive or bundled, preventing improper separate billing.

Question 3

Under Medicare's outpatient prospective payment system (OPPS), cardiology services in a hospital outpatient setting are reimbursed using:

Accepted Answer

Ambulatory payment classifications (APCs)

Answer

Hospital outpatient services including cardiology are paid under APCs, which group similar services for a fixed payment amount.

Question 4

A cardiology coder notes that a claim was denied with reason code CO-4. This typically means:

Accepted Answer

The procedure code is inconsistent with the modifier

Answer

CO-4 denial indicates the procedure code is inconsistent with the modifier used, requiring the coder to review and correct the modifier pairing.

Question 5

Incident-to billing in a cardiology practice allows a non-physician practitioner's services to be billed under the supervising physician's NPI at 100% of the fee schedule if:

Accepted Answer

The service is an extension of the physician's treatment plan with direct supervision present in the suite

Answer

Incident-to billing requires the supervising physician to be present in the office suite and the service to be part of the physician's established treatment plan.

CCC Practice Test

CCC Practice Test

CCC CCC Reimbursement & Payer Policies 2