CPB Practice Exam A with complete solutions

The office policy for claims follow-up is to prioritize the insurance balance accounts past 90 days by highest outstanding balance. Based on the A/R report provided, which payer type and aging category would be one of the top priorities on which to focus collection efforts? - Answer- workers' compensation, 121+ days Using the fee schedule and the payment policy provided, what is the expected reimbursement (including patient responsibility) when a provider performs a nasal endoscopy and dilation of the left maxillary sinus (31295) and a diagnostic nasal endoscopy of the right maxillary sinus (31233)? - Answer- $2475 Policy applies to all professional services performed in an office place of service: When a significant, separately identifiable E/M service (appended with modifier 25) and any service that has a global period indicator—as designated by CMS of 0, 10, 90 or YYY—is performed on the same day, the E/M service will be reimbursed at 50% of the contracted allowable. When performed in a facility, both services are paid at 100%. When the E/M value is greater than the procedure, the reduction will be applied to the global procedure code. Based on the remittance advice and the payment policy provided, what action is required for this claim? - Answer- D. The claim did not pay correctly. Both services should be paid at 100%. Contact the payer to reprocess the claim for full payment. Balloon Sinusplasty Medical Coverage Policy According to the LCD, how is an extracapsular cataract surgery with insertion of an intraocular lens for a drug induced cataract in the left eye reported? - Answer- 66984, H26.32, T38.0X5A I. Primary insurance II. Primary insurance ID number III. Relationship to the insured IV. Place of service V. Provider NPI VI. CPT® code(s) VII. Modifier VIII. Diagnosis code correlation IX. Units of service X. Service Facility Location Information (Robert Roberts) - Answer- VI , VIII and X The provider performs an office visit with an expanded problem focused history, expanded problem focused exam and low MDM to manage the patient's hypertension. The provider also destroys two plantar warts. How is this reported? - Answer- 99213-25, 17110 What is the correct HCPCS Level II code for Depo-Provera (medroxyprogesterone acetate) injection of 100 mg? - Answer- J1050 x 100 55-year-old female presents to the office with ongoing history of type I diabetes which has been controlled with insulin. During the exam the physician notes that gangrene has set in due to the diabetic peripheral angiopathy on her left great toe. Patient is recommended to see a general surgeon for treatment of the gangrene on her left great toe. - Answer- E10.52 A dermatologist performed an excision of a squamous cell carcinoma from the patients forehead with a 1.2 cm excised diameter. The excision site required an intermediate wound closure measuring 1.8 cm. What is/are the correct code(s)? - Answer- C. 11642, 12051-51 Procedures Performed: 1. Bilateral tympanotomy with insertion of ventilation tubes (69436 RVU 4.62) 2. Adenotonsillectomy (42820 RVU 8.41) What is/.are the correct code(s) and proper billing sequence for the following procedures performed by a physician? Procedures Performed: Bilateral tympanostomy with insertion of ventilationg tubes (69436 RVU 4.63582) Adenotonsillectomy (42820 RVU 8.45321) - Answer- A. 42820, 69436 When you respond to a patient with "How may I help you, Mrs Jones?", the use of the patient's name: - Answer- C. Indicates to the caller you are interested and listening Ms. Turner had surgery one month ago for hernia repair. She is still in the post-operative period and comes in today to the see the same physician that performed the hernia repair surgery about a lump that she has noticed on her tailbone. The physician performs an examination and the diagnosis is that she has a pilonidal cyst which is unrelated to the surgery. Can the physician bill an E/M service for today's visit during the post-operative period? - Answer- Yes, the E/M service can be reported with modifier 24 to indicate it is unrelated to the surgery. CMS has a standard enrollment form in which the provider agrees to: I. Submit claims to Medicare II. Have authorization from the Medicare beneficiary to file claims III. Retain all source documentation and medical records IV. Submit claims within 60 days of the date of service V. Submit all claims with a group NP