Reimbursement and Billing Flashcards
7 cards from real COBGC practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 7 Reimbursement and Billing flashcards as text
A bilateral tubal ligation is performed immediately following a vaginal delivery. How should this procedure be coded?
Answer: Billed separately with the appropriate sterilization procedure code
Postpartum tubal ligation is an elective sterilization procedure not included in the global obstetric package and is billed separately with its own procedure code.
Which modifier is used to report a gynecologic procedure performed bilaterally during the same operative session?
Answer: -50
Modifier -50 identifies bilateral procedures performed during the same operative session and typically results in 150% of the single-procedure payment rate.
A fetal non-stress test (NST) is performed in the physician's office at 36 weeks gestation. Which CPT code reports this service?
Answer: 59025
CPT 59025 is used to report the fetal non-stress test, which monitors fetal heart rate patterns in response to fetal movement.
Which billing practice involves submitting multiple procedure codes separately when a single comprehensive code should be used instead?
Answer: Unbundling
Unbundling is the inappropriate practice of separating services that should be reported as one comprehensive code, and it constitutes fraudulent billing.
An OB ultrasound is performed using hospital-owned equipment. The physician bills only for interpretation. Which modifier is used?
Answer: -26
Modifier -26 identifies the professional component only (physician interpretation and written report) when the technical component is billed separately by the facility.
The National Correct Coding Initiative (NCCI) edits are designed primarily to:
Answer: Prevent improper payment for services that should be bundled together
NCCI edits identify code combinations that should not be billed together because one code's services are considered inclusive of another code.
A GYN patient receives a well-woman preventive exam and also has a new complaint of abnormal uterine bleeding addressed in the same visit. How should this be reported?
Answer: Bill both the preventive medicine code and an E/M code with modifier -25
When a significant, separately identifiable problem-oriented E/M is provided on the same day as a preventive medicine service, both may be billed with modifier -25 appended to the E/M code.