CMA Medical Billing and Coding 3 — Questions and Answers
Question 1: Which section of the CPT manual contains codes for Evaluation and Management (E/M) services?
- 99100-99140
- 99202-99499 (Correct answer)
- 90281-90399
- 70010-79999
Correct answer: 99202-99499
E/M codes are found in the 99202-99499 range of the CPT manual and cover office visits, hospital care, and consultations.
Question 2: What is the significance of a 'clean claim' in medical billing?
- A claim submitted without any diagnosis codes
- A claim that meets all payer requirements and can be processed without additional information (Correct answer)
- A claim for preventive services only
- A claim submitted on paper rather than electronically
Correct answer: A claim that meets all payer requirements and can be processed without additional information
A clean claim contains all required information and is error-free, allowing the payer to process and pay it without requesting additional data.
Question 3: In CPT coding, what does the symbol '►◄' (triangle pointing right and left) adjacent to a code indicate?
- The code is new for the current year
- The code description has been revised
- Text around the symbol contains new or revised guidelines (Correct answer)
- The code has been deleted
Correct answer: Text around the symbol contains new or revised guidelines
The ►◄ symbols in CPT indicate that new or revised guidelines or parenthetical notes appear in that section.
Question 4: A patient's primary insurer pays 80% of the allowed amount. The secondary insurer is responsible for which portion?
- The full remaining 20% always
- The patient's entire deductible
- The remaining balance up to its own allowed amount, following coordination of benefits rules (Correct answer)
- Nothing, as secondary insurance never pays after primary
Correct answer: The remaining balance up to its own allowed amount, following coordination of benefits rules
Secondary insurance pays according to coordination of benefits (COB) rules, covering some or all of the remaining patient responsibility up to its own benefit limits.
Question 5: What is an Advance Beneficiary Notice (ABN)?
- A notice informing Medicare patients that a service may not be covered and they may be billed (Correct answer)
- A pre-authorization form required by private insurers
- A document authorizing release of medical records
- A referral form for specialist services
Correct answer: A notice informing Medicare patients that a service may not be covered and they may be billed
An ABN is a written notice given to Medicare beneficiaries before a service that Medicare may deny, allowing the provider to bill the patient if Medicare does not pay.
Question 6: Which type of health plan requires members to choose a primary care physician (PCP) who coordinates all care?
- PPO (Preferred Provider Organization)
- HMO (Health Maintenance Organization) (Correct answer)
- EPO (Exclusive Provider Organization)
- HSA (Health Savings Account)
Correct answer: HMO (Health Maintenance Organization)
HMOs require members to select a PCP who manages referrals to specialists and coordinates overall healthcare.
Question 7: What does CPT modifier -25 indicate?
- A reduced service was performed
- A significant, separately identifiable E/M service was performed on the same day as a procedure (Correct answer)
- The procedure was performed by a different physician
- Postoperative management only was provided
Correct answer: A significant, separately identifiable E/M service was performed on the same day as a procedure
Modifier -25 is appended to an E/M code to show that a separate, significant evaluation was performed on the same day as a minor procedure.
CMA Medical Billing and Coding 3
Which section of the CPT manual contains codes for Evaluation and Management (E/M) services?