CEHRS Medical Coding in EHR 2 — Questions and Answers
Question 1: Which coding system is primarily used for procedures performed in outpatient hospital settings and physician offices in the US?
- ICD-10-CM
- CPT (Current Procedural Terminology) (Correct answer)
- ICD-10-PCS
- SNOMED CT
Correct answer: CPT (Current Procedural Terminology)
CPT codes are used to report medical, surgical, and diagnostic procedures in outpatient and physician office settings.
Question 2: In EHR systems, what does the term 'superbill' refer to?
- A billing invoice sent directly to the patient
- A comprehensive charge capture form listing diagnoses and procedures for a visit (Correct answer)
- An override billing code for complex cases
- A supplemental insurance claim form
Correct answer: A comprehensive charge capture form listing diagnoses and procedures for a visit
A superbill is a charge capture document that lists the diagnoses (ICD codes) and procedures (CPT codes) performed during a patient encounter.
Question 3: What is the purpose of an Advance Beneficiary Notice (ABN) in medical coding?
- To authorize surgery in advance
- To notify Medicare patients that a service may not be covered so they can accept financial responsibility (Correct answer)
- To pre-approve inpatient admissions
- To document a patient's advanced directive
Correct answer: To notify Medicare patients that a service may not be covered so they can accept financial responsibility
An ABN informs Medicare beneficiaries that a service may be denied as not medically necessary, giving them the choice to proceed and accept responsibility for payment.
Question 4: Which HCPCS level covers supplies, equipment, and services not classified under CPT codes?
- HCPCS Level I
- HCPCS Level II (Correct answer)
- HCPCS Level III
- HCPCS Level IV
Correct answer: HCPCS Level II
HCPCS Level II codes (alphanumeric, beginning with letters A-V) cover supplies, durable medical equipment, ambulance services, and other non-physician services.
Question 5: What does the term 'upcoding' mean in the context of medical billing?
- Updating codes to the newest edition
- Assigning a higher-level code than the documentation supports to receive greater reimbursement (Correct answer)
- Using an unlisted code when no specific code exists
- Correcting a previously submitted claim
Correct answer: Assigning a higher-level code than the documentation supports to receive greater reimbursement
Upcoding is a form of fraud in which a provider bills a higher-level or more complex code than the services actually rendered.
Question 6: When a patient is seen for a follow-up visit for type 2 diabetes with diabetic chronic kidney disease, which ICD-10-CM convention guides code sequencing?
- Code the CKD first as the more severe condition
- Code diabetes first as the underlying cause; use a combination code if available (Correct answer)
- Code alphabetically by condition name
- Code the condition treated most recently first
Correct answer: Code diabetes first as the underlying cause; use a combination code if available
ICD-10-CM provides combination codes (e.g., E11.65) for diabetes with associated conditions; the diabetes code is sequenced first as the etiology.
Question 7: In EHR-based coding, what is the role of a 'code editor' or 'claims scrubber'?
- A person who manually reviews every claim before submission
- Automated software that checks claims for coding errors and payer rule violations before submission (Correct answer)
- A tool that converts SNOMED CT codes to ICD-10
- A compliance officer who audits past claims
Correct answer: Automated software that checks claims for coding errors and payer rule violations before submission
A claims scrubber automatically reviews claims for issues such as unbundling, missing modifiers, and payer-specific edits prior to submission to reduce denials.
CEHRS Medical Coding in EHR 2
Which coding system is primarily used for procedures performed in outpatient hospital settings and physician offices in the US?