CMAA Billing, Coding, and Claims 4

Question 1

A claim is returned to the medical office as 'unprocessable' due to a missing NPI. Which field on the CMS-1500 form contains the rendering provider's NPI?

Accepted Answer

Box 24J

Answer

Box 33a

Answer

Box 17b

Answer

Box 21

Question 2

Which modifier is appended to a CPT code to indicate a service was performed by a physician assistant under the supervision of a physician?

Accepted Answer

-AS

Answer

-80

Answer

-SA

Answer

-GC

Question 3

A patient's EOB shows a 'crossover claim' notation. What does this mean?

Accepted Answer

The claim was forwarded from Medicare to a secondary payer automatically

Answer

The claim was denied and resubmitted

Answer

The patient has two primary insurances

Answer

The claim requires additional documentation

Question 4

Under the ICD-10-CM guidelines, when coding an encounter for a patient with a personal history of colon cancer who is now in remission, which code category is used?

Accepted Answer

Z85.3

Answer

C18

Answer

Z85.038

Answer

D12

Question 5

Which of the following is the correct order for entering diagnosis codes on a claim when a patient has multiple conditions?

Accepted Answer

Principal/primary diagnosis first, then additional diagnoses

Answer

Alphabetical by condition name

Answer

Chronic conditions always listed first

Answer

Most expensive condition first

Question 6

A claim for an office visit is denied with code CO-4 (Inconsistent with the modifier). What is the most likely issue?

Accepted Answer

The modifier used is not appropriate for the CPT code billed

Answer

The modifier does not affect reimbursement for this service

Answer

The claim was submitted to the wrong payer

Answer

The patient's deductible has not been met

Question 7

What is the purpose of the Coordination of Benefits (COB) clause in health insurance?

Accepted Answer

To prevent duplicate payments when a patient has multiple insurance plans

Answer

To allow patients to choose their primary insurer each year

Answer

To determine which diagnoses are covered under each plan

Answer

To calculate patient copayments across all plans