CPC Code Validation & Billing Procedures 4

Question 1

Which section of the CMS-1500 (02-12) claim form is used to report the patient's diagnosis codes?

Accepted Answer

Box 21

Answer

Box 21 on the CMS-1500 is designated for listing up to 12 ICD-10-CM diagnosis codes that support the services billed.

Question 2

A claim edit flags a CPT code as requiring prior authorization that was not obtained. The authorization was actually obtained but not listed on the claim. What is the appropriate correction?

Accepted Answer

Add the authorization number to the appropriate field and resubmit the claim

Answer

When a prior authorization exists but was omitted from the claim, adding the authorization number in the correct field and resubmitting resolves this edit.

Question 3

What is the key difference between a claim 'rejection' and a claim 'denial'?

Accepted Answer

A rejection occurs before adjudication due to technical errors; a denial occurs after adjudication on clinical or coverage grounds

Answer

Rejections are returned before the payer processes the claim due to missing or invalid data, while denials are issued after review when the payer decides not to pay.

Question 4

A procedure has an asterisk (*) next to it in the CPT manual. What does this historically indicate?

Accepted Answer

A surgical package does not apply and the procedure is billed as separate components

Answer

In older CPT editions, an asterisk indicated a starred procedure, meaning the surgical package rules did not apply and components were billed separately; this concept informs current coding practices.

Question 5

Which of the following is NOT included in the global surgical package?

Accepted Answer

Treatment of unrelated conditions during the post-operative period

Answer

Treatment of conditions unrelated to the surgery is NOT bundled in the global surgical package and may be billed separately with modifier -79.

(CPC) Certified Procedural Coder Practice Test

(CPC) Certified Procedural Coder Practice Test

CPC Code Validation & Billing Procedures 4