CPB PRACTICE EXAM 79 COMPREHENSIVE
STUDY GUIDE WITH SOLUTIONS
◉ What is an Accountable Care Organization (ACO)?
A. Groups of doctors, hospitals, and other health care providers who
coordinate high quality care to Medicare patients.
B. An insurance carrier that provides a set fee based on the diagnosis
of the patient.
C. A group of providers who contract with a third party
administrator to pay fee for service for services.
D. Hospitals who see a subset of patients for cost efficiency.
Answer: A. Groups of doctors, hospitals, and other health care
providers who coordinate high quality care to Medicare patients.
◉ A new patient presents for her annual exam and has no
complaints. She is scheduled to see the physician assistant (PA).
How should services be billed ?
A. Bill under the PA.
B. A new patient can be billed incident to the physician.
C. The PA cannot see new patients.
D. Reschedule the patient with the physician
,Answer: A. Bill under the PA.
◉ CPT® codes 12032 and 12001 were reported together for a 2.6
cm intermediate repair of a laceration to the right arm and a 2.5 cm
simple repair of a laceration to the left arm. 12001 was denied as a
bundled service. What action should be taken by the biller
(following the CPT® guidelines)?
A. Write-off the charge for 12001 as it is a bundled procedure.
B. Resubmit a corrected claim as 12032, 12001-59.
C. Transfer the charge to patient responsibility.
D. Resubmit a corrected claim as 12032, 12001-51.
Answer: B. Resubmit a corrected claim as 12032, 12001-59.
◉ According to CMS, which of the following services are included in
the global package for surgical procedures?
I. Surgical procedure performed
II. E/M visits unrelated to the diagnosis for which the surgical
procedure is performed
III. Local infiltration, digital block, or topical anesthesia
IV. Treatment for postoperative complication which requires a
return trip to the operating room (OR)V. Writing Orders
VI. Postoperative infection treated in the office
,A. I, III, V, VI
B. I, IV, V
C. I, II, III, V
D. I-VI
Answer: A. I, III, V, VI
◉ Which CPT® code below can be reported with modifier 51?
A. 17004
B. 17312
C. 19101
D. 19126
Answer: C. 19101
◉ A HCPCS/CPT® code is assigned "1" in the MUE file. What does
this indicate?
A. Code pairs cannot be reported together.
B. Codes can be reported together if documented. Append modifier
59.
, C. The code can only be reported for one unit of service on a single
date of service.
D. Medically unlikely the code pair is performed together.
Answer: C. The code can only be reported for one unit of service on a
single date of service.
◉ Electronic Healthcare Transactions and code sets are required to
be used by health plans, healthcare clearinghouses and healthcare
providers that participate in electronic data interchanges. Which of
the following are requirements for the code sets?
I. Dental services are reported with CDT codes
II. Inpatient procedures are reported with HCPCS Level II codes
III. Diagnosis codes are reported with ICD-10-CM and ICD-10-PCS
codes
IV. Outpatient services are reported with CPT® and HCPCS Level II
codes
V. Physician services are reported with ICD-10-PCS codes
A. I and IV
B. II, III, and V
C. II, III, and IV
D. II and IV
Answer: A. I and IV
STUDY GUIDE WITH SOLUTIONS
◉ What is an Accountable Care Organization (ACO)?
A. Groups of doctors, hospitals, and other health care providers who
coordinate high quality care to Medicare patients.
B. An insurance carrier that provides a set fee based on the diagnosis
of the patient.
C. A group of providers who contract with a third party
administrator to pay fee for service for services.
D. Hospitals who see a subset of patients for cost efficiency.
Answer: A. Groups of doctors, hospitals, and other health care
providers who coordinate high quality care to Medicare patients.
◉ A new patient presents for her annual exam and has no
complaints. She is scheduled to see the physician assistant (PA).
How should services be billed ?
A. Bill under the PA.
B. A new patient can be billed incident to the physician.
C. The PA cannot see new patients.
D. Reschedule the patient with the physician
,Answer: A. Bill under the PA.
◉ CPT® codes 12032 and 12001 were reported together for a 2.6
cm intermediate repair of a laceration to the right arm and a 2.5 cm
simple repair of a laceration to the left arm. 12001 was denied as a
bundled service. What action should be taken by the biller
(following the CPT® guidelines)?
A. Write-off the charge for 12001 as it is a bundled procedure.
B. Resubmit a corrected claim as 12032, 12001-59.
C. Transfer the charge to patient responsibility.
D. Resubmit a corrected claim as 12032, 12001-51.
Answer: B. Resubmit a corrected claim as 12032, 12001-59.
◉ According to CMS, which of the following services are included in
the global package for surgical procedures?
I. Surgical procedure performed
II. E/M visits unrelated to the diagnosis for which the surgical
procedure is performed
III. Local infiltration, digital block, or topical anesthesia
IV. Treatment for postoperative complication which requires a
return trip to the operating room (OR)V. Writing Orders
VI. Postoperative infection treated in the office
,A. I, III, V, VI
B. I, IV, V
C. I, II, III, V
D. I-VI
Answer: A. I, III, V, VI
◉ Which CPT® code below can be reported with modifier 51?
A. 17004
B. 17312
C. 19101
D. 19126
Answer: C. 19101
◉ A HCPCS/CPT® code is assigned "1" in the MUE file. What does
this indicate?
A. Code pairs cannot be reported together.
B. Codes can be reported together if documented. Append modifier
59.
, C. The code can only be reported for one unit of service on a single
date of service.
D. Medically unlikely the code pair is performed together.
Answer: C. The code can only be reported for one unit of service on a
single date of service.
◉ Electronic Healthcare Transactions and code sets are required to
be used by health plans, healthcare clearinghouses and healthcare
providers that participate in electronic data interchanges. Which of
the following are requirements for the code sets?
I. Dental services are reported with CDT codes
II. Inpatient procedures are reported with HCPCS Level II codes
III. Diagnosis codes are reported with ICD-10-CM and ICD-10-PCS
codes
IV. Outpatient services are reported with CPT® and HCPCS Level II
codes
V. Physician services are reported with ICD-10-PCS codes
A. I and IV
B. II, III, and V
C. II, III, and IV
D. II and IV
Answer: A. I and IV
