CMA Medical Billing and Coding 4 — Questions and Answers
Question 1: What is the global surgical package in CPT billing?
- A bundle of unrelated procedures coded together for a discount
- Pre-operative, intra-operative, and routine post-operative care included in a single surgical fee (Correct answer)
- A group plan for employees of surgical centers
- A package price negotiated between hospital and insurer
Correct answer: Pre-operative, intra-operative, and routine post-operative care included in a single surgical fee
The global surgical package bundles pre-op evaluation, the procedure itself, and standard post-op follow-up into one surgical fee.
Question 2: Which ICD-10-CM code category (Z codes) is used to indicate a patient's history of cancer when the cancer is no longer present?
- Z codes for contact/exposure
- Z codes for personal history of malignancy (Correct answer)
- Z codes for screening examinations
- Z codes for family history
Correct answer: Z codes for personal history of malignancy
Personal history Z codes (such as Z85) are used when a patient had a malignancy in the past that has been excised or resolved and is no longer under treatment.
Question 3: A provider writes off the difference between their billed charge and the insurer's allowed amount. This write-off is called:
- Co-pay
- Deductible
- Contractual adjustment (Correct answer)
- Coordination of benefits
Correct answer: Contractual adjustment
A contractual adjustment is the amount a provider agrees to write off as part of their contract with the payer, reducing the billed charge to the allowed amount.
Question 4: Which HCPCS Level II code range is used for durable medical equipment (DME)?
- A codes (A0000-A9999)
- E codes (E0100-E9999) (Correct answer)
- J codes (J0000-J9999)
- L codes (L0000-L9999)
Correct answer: E codes (E0100-E9999)
HCPCS Level II E codes cover durable medical equipment such as wheelchairs, walkers, and hospital beds.
Question 5: What is the purpose of a charge master (chargemaster) in a hospital setting?
- It lists all credentialed providers in the facility
- It is a comprehensive list of all services, procedures, and supplies with their standard prices (Correct answer)
- It tracks patient appointment schedules
- It documents insurance authorizations
Correct answer: It is a comprehensive list of all services, procedures, and supplies with their standard prices
The chargemaster is a hospital's master price list linking services and supplies to their standard charges and corresponding billing codes.
Question 6: Under the Medicare Physician Fee Schedule, what does the Resource-Based Relative Value Scale (RBRVS) measure?
- The number of patients seen per hour
- The relative work, practice expense, and malpractice expense for each CPT code (Correct answer)
- The geographic location of the provider's practice
- The patient's ability to pay for services
Correct answer: The relative work, practice expense, and malpractice expense for each CPT code
RBRVS assigns relative value units (RVUs) based on physician work, practice expenses, and malpractice costs to calculate Medicare payment for each procedure.
Question 7: Which condition would be coded as the principal diagnosis in an inpatient hospital stay according to UHDDS guidelines?
- The condition present on admission that required the most nursing care
- The condition established after study to be chiefly responsible for causing the admission (Correct answer)
- The patient's most chronic and long-standing condition
- The condition listed first by the attending physician
Correct answer: The condition established after study to be chiefly responsible for causing the admission
Per UHDDS (Uniform Hospital Discharge Data Set) guidelines, the principal diagnosis is the condition determined after study to be chiefly responsible for the inpatient admission.
CMA Medical Billing and Coding 4
What is the global surgical package in CPT billing?