CMAS Medical Billing & Coding 2 — Questions and Answers
Question 1: Which modifier is appended to a CPT code to indicate that a procedure was performed on the left side of the body?
- Modifier -RT
- Modifier -LT (Correct answer)
- Modifier -51
- Modifier -50
Correct answer: Modifier -LT
Modifier -LT (Left Side) is used to identify procedures performed on the left side of the body.
Question 2: A patient has Medicare as primary insurance and Medicaid as secondary. What billing process applies?
- Bill Medicaid first, then Medicare
- Bill Medicare first, then Medicaid for the remaining balance (Correct answer)
- Bill both simultaneously
- Bill only the higher-paying insurer
Correct answer: Bill Medicare first, then Medicaid for the remaining balance
Medicare is always billed first as the primary payer, and Medicaid pays last as the payer of last resort.
Question 3: What does the ICD-10-CM code Z23 represent?
- Injury from immunization
- Encounter for immunization (Correct answer)
- Adverse effect of vaccine
- Follow-up after vaccination
Correct answer: Encounter for immunization
Z23 is the ICD-10-CM code for Encounter for immunization, used when a patient receives a vaccine.
Question 4: Which claim form is used to bill Medicare for professional services rendered by a physician?
- UB-04
- CMS-1500 (Correct answer)
- ADA Dental Claim Form
- CMS-1450
Correct answer: CMS-1500
The CMS-1500 form is the standard claim form used by physicians and other non-institutional providers to bill Medicare.
Question 5: What is the purpose of a remittance advice (RA)?
- To notify the patient of their outstanding balance
- To explain how the insurance company processed and paid a claim (Correct answer)
- To authorize a referral to a specialist
- To confirm patient eligibility for coverage
Correct answer: To explain how the insurance company processed and paid a claim
A remittance advice is sent by the payer to the provider to explain how each claim was adjudicated and what was paid.
Question 6: When a procedure is bundled into another under the NCCI edits, what does this mean for billing?
- Both codes can be billed with a modifier
- The component code cannot be billed separately with the comprehensive code (Correct answer)
- The provider must choose the higher-paying code
- Both codes require prior authorization
Correct answer: The component code cannot be billed separately with the comprehensive code
NCCI (National Correct Coding Initiative) edits bundle component procedures into a comprehensive code to prevent unbundling and duplicate payment.
Question 7: A claim is returned to the provider because a required field is missing. This is known as a:
- Denied claim
- Rejected claim (Correct answer)
- Adjusted claim
- Voided claim
Correct answer: Rejected claim
A rejected claim is returned before adjudication because it contains missing or invalid data that prevents processing.
CMAS Medical Billing & Coding 2
Which modifier is appended to a CPT code to indicate that a procedure was performed on the left side of the body?