CRCR CRCR - Certified Revenue Cycle Representative Program Charge Capture and Coding 3 — Questions and Answers
Question 1: Which modifier is appended to a CPT code to indicate that a procedure was performed on the left side of the body?
- Modifier -50
- Modifier -LT (Correct answer)
- Modifier -RT
- Modifier -51
Correct answer: Modifier -LT
Modifier -LT (Left Side) is used to identify procedures performed on the left side of the body.
Question 2: A patient presents to the ED and the physician documents a high-complexity medical decision making with greater than 60 minutes of total time. Which E/M level is most appropriate?
- 99283
- 99284
- 99285 (Correct answer)
- 99286
Correct answer: 99285
99285 represents the highest standard ED E/M level, requiring high-complexity MDM or 60+ minutes of time.
Question 3: What is the primary purpose of a charge description master (CDM) review?
- To verify patient insurance eligibility
- To ensure charge codes are accurate, compliant, and map correctly to payer requirements (Correct answer)
- To reconcile accounts receivable balances
- To generate prior authorization requests
Correct answer: To ensure charge codes are accurate, compliant, and map correctly to payer requirements
A CDM review ensures that all charge items have accurate codes, descriptions, and revenue codes that comply with payer and regulatory requirements.
Question 4: Under HIPAA, which code set is mandated for reporting professional services in outpatient settings?
- ICD-10-PCS
- CPT/HCPCS Level I (Correct answer)
- SNOMED CT
- DRG codes
Correct answer: CPT/HCPCS Level I
HIPAA mandates CPT/HCPCS Level I codes for reporting physician and outpatient professional services on claims.
Question 5: Which of the following best describes 'unbundling' in coding?
- Billing multiple services under one code
- Reporting component services separately when a comprehensive code should be used (Correct answer)
- Combining two procedures into a single claim line
- Using a higher-level code than documented
Correct answer: Reporting component services separately when a comprehensive code should be used
Unbundling occurs when individual component codes are billed separately instead of using the correct comprehensive bundled code, which is a compliance violation.
Question 6: A coder is reviewing a record where the physician documents 'probable pneumonia.' In the inpatient setting, how should this be coded?
- Code only the presenting symptoms such as cough and fever
- Code the condition as if confirmed (pneumonia) (Correct answer)
- Leave the diagnosis field blank pending confirmation
- Query the physician before assigning any code
Correct answer: Code the condition as if confirmed (pneumonia)
UHDDS guidelines allow inpatient coders to code 'probable,' 'suspected,' and 'likely' diagnoses as if confirmed at the time of discharge.
Question 7: Which revenue code is typically associated with pharmacy charges on a UB-04 claim form?
- 0250 (Correct answer)
- 0450
- 0300
- 0120
Correct answer: 0250
Revenue code 0250 (and its subcategories) is used to report pharmacy charges on the UB-04 institutional claim form.
CRCR CRCR - Certified Revenue Cycle Representative Program Charge Capture and Coding 3
Which modifier is appended to a CPT code to indicate that a procedure was performed on the left side of the body?