CRCR CRCR - Certified Revenue Cycle Representative Program Claims Processing and Billing 5

Question 1

What is the function of modifier 59 when appended to a CPT procedure code?

Accepted Answer

It indicates a distinct procedural service performed on the same day, separate from other services billed

Answer

Modifier 59 is used to show that a procedure or service was distinct or independent from other services performed on the same day, often to bypass bundling edits.

Question 2

Which of the following best describes a 'crossover claim' in Medicare/Medicaid billing?

Accepted Answer

A claim that Medicare automatically forwards to a secondary payer such as Medicaid after adjudication

Answer

After Medicare adjudicates a claim for a dual-eligible beneficiary, it automatically sends a crossover claim to the state Medicaid program for secondary payment.

Question 3

A claim is denied with reason code CO-97. What does this indicate?

Accepted Answer

The benefit for this service is included in the payment or allowance for another service already adjudicated

Answer

CO-97 means the service was bundled into another procedure already paid, indicating the billed code cannot be separately reimbursed.

Question 4

What is the purpose of the National Correct Coding Initiative (NCCI) edits maintained by CMS?

Accepted Answer

To prevent improper payment of CPT codes that should not be billed together

Answer

NCCI edits are CMS-developed code pair tables that identify procedure code combinations that are not payable together because one is considered part of the other.

Question 5

When a provider performs the same procedure bilaterally on the same operative session, which modifier is typically appended?

Accepted Answer

Modifier 50

Answer

Modifier 50 is appended to a CPT code to indicate that an identical procedure was performed on both sides of the body during the same session.

CRCR - Certified Revenue Cycle Representative Program Practice Test

CRCR - Certified Revenue Cycle Representative Program Practice Test

CRCR CRCR - Certified Revenue Cycle Representative Program Claims Processing and Billing 5