CRCR CRCR - Certified Revenue Cycle Representative Program Charge Capture and Coding 4 — Questions and Answers
Question 1: What does the 'global surgical package' concept mean in CPT coding?
- A bundle of all hospital services for a surgical admission
- Preoperative, intraoperative, and standard postoperative care included in one surgical code (Correct answer)
- A discount applied when multiple surgeries are performed
- A grouping of related surgical codes billed together
Correct answer: Preoperative, intraoperative, and standard postoperative care included in one surgical code
The global surgical package includes pre-op evaluation, the surgery itself, and routine post-op care within a defined period (0, 10, or 90 days).
Question 2: Which ICD-10-CM coding guideline applies when a patient is admitted for chemotherapy and also has the malignancy being treated?
- Code the malignancy as the principal diagnosis
- Code the chemotherapy encounter (Z51.11) as the principal diagnosis (Correct answer)
- Code complications of chemotherapy first
- Code the most resource-intensive condition first
Correct answer: Code the chemotherapy encounter (Z51.11) as the principal diagnosis
When the purpose of admission is chemotherapy, the encounter for antineoplastic chemotherapy (Z51.11) is sequenced as the principal diagnosis, with the malignancy coded additionally.
Question 3: A hospital bills a service using revenue code 0360 (operating room). Which type of charge does this represent?
- Ancillary service charge
- Room and board charge
- Professional fee charge
- Facility/technical component charge (Correct answer)
Correct answer: Facility/technical component charge
Revenue code 0360 represents operating room facility charges, which are the technical/facility component billed by the hospital on a UB-04.
Question 4: When a physician performs two separate, distinct procedures during the same operative session, modifier -51 is appended to:
- The primary (highest-value) procedure
- The secondary (additional) procedure(s) (Correct answer)
- Both procedures equally
- Neither procedure; list them in separate claims
Correct answer: The secondary (additional) procedure(s)
Modifier -51 (Multiple Procedures) is appended to the secondary and subsequent procedures, not the primary procedure, to indicate multiple procedures were performed.
Question 5: What is the correct action when a charge capture team identifies a service that was performed but never entered into the billing system?
- Write off the charge to avoid a late claim
- Conduct a late charge entry within the facility's defined timely filing window (Correct answer)
- Bill the patient directly without insurance
- Document the miss and take no further billing action
Correct answer: Conduct a late charge entry within the facility's defined timely filing window
A missed charge should be submitted via a late charge process as long as it falls within the payer's timely filing deadline to ensure appropriate reimbursement.
Question 6: In ICD-10-CM, what does a 7th character 'A' indicate when used with a fracture code?
- The fracture is an adverse effect of treatment
- The encounter is for active treatment of the fracture (Correct answer)
- The fracture is a subsequent encounter with delayed healing
- The fracture is a sequela
Correct answer: The encounter is for active treatment of the fracture
A 7th character 'A' designates the initial encounter, meaning the patient is receiving active treatment for the fracture.
Question 7: Which type of HCPCS Level II code is primarily used to report durable medical equipment (DME)?
- A codes
- E codes (Correct answer)
- G codes
- J codes
Correct answer: E codes
HCPCS Level II 'E' codes are specifically designated for durable medical equipment, orthotics, and prosthetics.
CRCR CRCR - Certified Revenue Cycle Representative Program Charge Capture and Coding 4
What does the 'global surgical package' concept mean in CPT coding?