CRCR Charge Capture and Coding 5

Question 1

Which of the following coding practices violates the False Claims Act?

Accepted Answer

Deliberately assigning codes that maximize reimbursement beyond what documentation supports

Answer

Intentionally assigning codes to maximize payment beyond what is documented and clinically appropriate constitutes a false claim and violates the False Claims Act.

Question 2

A revenue cycle analyst notices that multiple DRGs are being 'optimized' by consistently adding a CC code that appears in very few records compared to national benchmarks. This pattern suggests:

Accepted Answer

Potential upcoding or DRG manipulation requiring a compliance review

Answer

A statistical outlier in CC/MCC rates compared to benchmarks is a red flag for upcoding, inappropriate query practices, or documentation inflation.

Question 3

Under CPT guidelines, an Evaluation and Management (E/M) visit on the same day as a procedure is generally:

Accepted Answer

Bundled into the procedure unless a separately identifiable service is documented and modifier -25 is appended

Answer

A same-day E/M service is payable separately only when it is significant, separately identifiable, and documented beyond the decision to perform the procedure, requiring modifier -25.

Question 4

Which of the following accurately describes a 'soft coding' environment?

Accepted Answer

Codes are suggested by an encoder and reviewed/approved by a coding professional before billing

Answer

In a soft coding environment, computer-assisted or encoder-suggested codes are reviewed and validated by a credentialed coder before claim submission.

Question 5

A patient undergoes a bilateral knee arthroscopy. How should CPT coding typically reflect this?

Accepted Answer

Report the unilateral arthroscopy code twice with modifier -50 (Bilateral Procedure)

Answer

When a procedure is performed bilaterally and no specific bilateral code exists, the unilateral code is reported with modifier -50 to indicate bilateral performance.

CRCR - Certified Revenue Cycle Representative Program Practice Test

CRCR - Certified Revenue Cycle Representative Program Practice Test

CRCR Charge Capture and Coding 5