CMAS Medical Billing & Coding 3 — Questions and Answers
Question 1: Which ICD-10-CM code category is used for external cause codes that describe how an injury occurred?
- S codes
- T codes
- V-Y codes (Correct answer)
- Z codes
Correct answer: V-Y codes
V through Y codes in ICD-10-CM are external cause codes that describe the circumstances of an injury or health condition.
Question 2: What does CPT code 99213 represent?
- New patient office visit, low complexity
- Established patient office visit, low-to-moderate complexity (Correct answer)
- Preventive care visit for an adult
- Consultation with a specialist
Correct answer: Established patient office visit, low-to-moderate complexity
CPT 99213 is an established patient office visit requiring a medically appropriate history/exam and low-to-moderate medical decision making.
Question 3: A provider writes off the difference between their billed charge and the payer's allowed amount. This is called a:
- Co-payment
- Deductible
- Contractual adjustment (Correct answer)
- Write-off for bad debt
Correct answer: Contractual adjustment
A contractual adjustment is the difference between the billed amount and the payer's contracted fee schedule amount that the provider agrees to write off.
Question 4: Which HCPCS Level II code range covers durable medical equipment (DME)?
- A codes
- E codes (Correct answer)
- L codes
- K codes
Correct answer: E codes
HCPCS Level II E codes (E0100–E9999) represent durable medical equipment such as wheelchairs, walkers, and hospital beds.
Question 5: What is the global period for a minor surgical procedure?
- 0 days
- 10 days (Correct answer)
- 30 days
- 90 days
Correct answer: 10 days
Minor surgical procedures typically have a 10-day global period during which related follow-up care is included in the procedure fee.
Question 6: Which payer is responsible for payment when a patient is injured in a workplace accident?
- The patient's private health insurance
- Medicare
- Workers' compensation insurance (Correct answer)
- Medicaid
Correct answer: Workers' compensation insurance
Workers' compensation insurance is the primary payer for injuries or illnesses arising out of and in the course of employment.
Question 7: What information is contained in Box 21 of the CMS-1500 claim form?
- CPT procedure codes
- Referring physician NPI
- Diagnosis codes (ICD-10-CM) (Correct answer)
- Date of service
Correct answer: Diagnosis codes (ICD-10-CM)
Box 21 of the CMS-1500 form contains up to 12 ICD-10-CM diagnosis codes that support the medical necessity of the services billed.
CMAS Medical Billing & Coding 3
Which ICD-10-CM code category is used for external cause codes that describe how an injury occurred?