AAPC CPB - Chapter 9 Practical Application Questions 2024.

AAPC CPB - Chapter 9 Practical Application Questions 2024.Case 1 - Clearinghouse Rejections Report Status: 11/19/20XX Contents: C4450 - Principal Diagnosis Code must be valid; REJECTED BY SYSTEM EDI; Rejected Patient Name: Adams, David Patient Number: 384594 Payer: HEALTHSPRINGMEDICARE Submission Date: 11/19/XX Date of Service: 11/09/XX Charge: $557.00 Provider: Post, Alexis According to this clearinghouse rejections report, what actions should be taken on the claim for David Adams, Date of Service 11/19/20XX? I. Review the medical records to verify the ICD-10-CM code is correct. II. Review the ICD-10-CM codebook to verify it is a correct diagnosis code. III. Adjust the charge as this is not a covered diagnosis by the insurance carrier. IV. Override the clearinghouse edit as this is a valid code. a. II and III b. I and II c. I, II, and IV d. II and IV - ANSWER b. I and II Response Feedback: According to the Clearinghouse report, the diagnosis code is invalid. The biller should look in the ICD-10-CM codebook to determine the validity of the code. In the ICD-10-CM codebook, the code requires another character. The medical record should be reviewed to determine the additional character and a correct claim refiled. Case 2 - Clearinghouse Rejections Report Status: 10/18/20XX Contents: C4655 - Not eligible (Inactive) for service; REJECTED BY SYSTEM EDI; Rejected Patient Name: Smith, John Patient Number: 584263 Payer: AAPC Health Plan Submission Date: 10/18/XX