CPC Code Validation & Billing Procedures 2

Question 1

A claim is returned because the ICD-10-CM diagnosis code does not support medical necessity for the CPT procedure billed. What is the coder's first action?

Accepted Answer

Review the clinical documentation to find a more specific or additional supporting diagnosis

Answer

Submit an appeal immediately

Answer

Change the procedure code to match the diagnosis

Answer

Write off the claim as a denial

Question 2

Which modifier is appended to a CPT code to indicate that a procedure was performed on the right side of the body?

Accepted Answer

-RT

Answer

-LT

Answer

-50

Answer

-51

Question 3

An Explanation of Benefits (EOB) shows a claim was denied for 'duplicate billing.' The coder confirms the service was only billed once. What should the coder do?

Accepted Answer

File an appeal with documentation proving the service was rendered only once

Answer

Accept the denial and write off the balance

Answer

Re-submit the claim without changes

Answer

Bill the patient for the full amount

Question 4

What does the term 'bundling' refer to in the context of claim validation?

Accepted Answer

The payer's practice of combining payment for related procedures into a single allowable

Answer

Submitting multiple claims for the same patient on the same date

Answer

Grouping multiple patients on one claim form

Answer

Attaching supporting documentation to a claim

Question 5

A coder notices the claim form lists the rendering provider's NPI in Box 24J but the billing provider's NPI is missing from Box 33a on the CMS-1500. What is the likely outcome?

Accepted Answer

The claim will be rejected for missing required billing provider information

Answer

The claim will process normally

Answer

The payer will auto-populate the billing NPI

Answer

The claim will be denied for medical necessity

Question 6

Which of the following best describes a 'clean claim'?

Accepted Answer

A claim that contains all required data elements and passes all payer edits upon first submission

Answer

A claim with no outstanding patient balance

Answer

A claim submitted on paper rather than electronically

Answer

A claim that has been resubmitted after a denial

Question 7

When a procedure is performed during the global surgical period of a prior procedure, and the new service is unrelated, which modifier should be used?

Accepted Answer

-79

Answer

-78

Answer

-24

Answer

-58