MEDICAL BILLING BASICS QUESTIONS
AND ANSWERS WITH SOLUTIONS 2024
Which types of codes are reported for tracking purposes only for outpatient facility coding? - ANSWER
ICD-10-PCS
When a medical biller is working for an ambulatory surgical center, the services reported on the CMS-
1500 claim form for which third party payer? - ANSWER Medicare
In the outpatient billing process which of the following is an example of demographic information? -
ANSWER Third party payer name
A 56-year-old gentleman presents to the emergency room with an ingrown toenail on his left first toe.
He states he has had problems with this since March of this year. He continues to have some weeping
from the lateral nail bed. Pain is most noticeable with walking. He receives a toe block, using 1%
lidocaine, to both the medial and lateral border of the left first toe. Appropriate local analgesia is
obtained, under sterile fashion, and the patient receives a partial nail bed resection, without
complications. The nail is dressed and the patient instructed on care. Which claim form would the
emergency room service be billed on? - ANSWER UB-04
Which form would the emergency room physician services for the ingrown toenail care described in the
previous question be billed on? - ANSWER CMS-1500
Revenue codes describe the type of services rendered. Who enters the revenue codes on the UB-04
claim form? - ANSWER medical biller
What is the last step in the medical billing process? - ANSWER PATIENT STATEMENT AND CLAIM FORM
A 76-year-old white male, established patient with this office, presents with 1-week history of right
upper quadrant pain which is constantly there, but waxes and wanes in intensity. The patient was seen in
the emergency room one week ago with normal laboratories and normal chest x-ray. The pain was felt to
be pleuritic in nature. He was given a shot of Toradol, which did not help. The patient states that his
appetite is okay and that his bowels are okay. No hematochezia and no melena. The patient does have a
history of abdominal aortic aneurysm. Which claim form would this followup visit be billed on? -
ANSWER CMS-1500
, In the outpatient billing process the medical coders main responsibility is to assign which of the
following? - ANSWER diagnosis and procedure codes
The patient is a 55-year-old male new patient who is referred to a consulting physician for evaluation of
his right knee. He has had a 4-month history of gradually increasing right knee pain. He says he has
always had a little difficulty with his knee over the last several years but has noted locking and catching
after an injury last year. He underwent lateral meniscectomy, and did receive considerable benefit from
that. But again, in the last 4 months he has developed increasing lateral joint pain of the right knee.
Which claim form would these professional consultation services be billed on? - ANSWER CMS-1500
In which healthcare setting is their an exception to which claim form from Medicare are reported on? -
ANSWER Ambulatory surgical center
This 16-month-old white male is noted to have increased swelling of right groin area. This would reduce
when supine. There was also an undescended testis in the right hemiscrotum. The patient presents at
this time to the same day surgery unit of Sunshine Hospital for orchiopexy and repair of hernia. Which
claim form would the surgery facility services be billed on? - ANSWER UB-04
The medical coding specialist assigns codes from which codebooks for inpatient facility coding? -
ANSWER ICD-10-CM and ICD-10-PCS
Outpatient facilities are required to report ICD-10-PCS codes to receive reimbursement for the services
rendered - ANSWER False
The chargemaster is a healthcare provider's comprehensive price list of all supplies, services, and
equipment usage fees for patient care. - ANSWER True
Charge sheets for outpatient providers usually list the most common diagnosis and procedures. -
ANSWER True
Demographic information is used to determine which departments submitted the charges for the
services rendered. - ANSWER False
This is a claim form used by hospitals, nursing facilities, in patient, and other facility providers. - ANSWER
UB-04
AND ANSWERS WITH SOLUTIONS 2024
Which types of codes are reported for tracking purposes only for outpatient facility coding? - ANSWER
ICD-10-PCS
When a medical biller is working for an ambulatory surgical center, the services reported on the CMS-
1500 claim form for which third party payer? - ANSWER Medicare
In the outpatient billing process which of the following is an example of demographic information? -
ANSWER Third party payer name
A 56-year-old gentleman presents to the emergency room with an ingrown toenail on his left first toe.
He states he has had problems with this since March of this year. He continues to have some weeping
from the lateral nail bed. Pain is most noticeable with walking. He receives a toe block, using 1%
lidocaine, to both the medial and lateral border of the left first toe. Appropriate local analgesia is
obtained, under sterile fashion, and the patient receives a partial nail bed resection, without
complications. The nail is dressed and the patient instructed on care. Which claim form would the
emergency room service be billed on? - ANSWER UB-04
Which form would the emergency room physician services for the ingrown toenail care described in the
previous question be billed on? - ANSWER CMS-1500
Revenue codes describe the type of services rendered. Who enters the revenue codes on the UB-04
claim form? - ANSWER medical biller
What is the last step in the medical billing process? - ANSWER PATIENT STATEMENT AND CLAIM FORM
A 76-year-old white male, established patient with this office, presents with 1-week history of right
upper quadrant pain which is constantly there, but waxes and wanes in intensity. The patient was seen in
the emergency room one week ago with normal laboratories and normal chest x-ray. The pain was felt to
be pleuritic in nature. He was given a shot of Toradol, which did not help. The patient states that his
appetite is okay and that his bowels are okay. No hematochezia and no melena. The patient does have a
history of abdominal aortic aneurysm. Which claim form would this followup visit be billed on? -
ANSWER CMS-1500
, In the outpatient billing process the medical coders main responsibility is to assign which of the
following? - ANSWER diagnosis and procedure codes
The patient is a 55-year-old male new patient who is referred to a consulting physician for evaluation of
his right knee. He has had a 4-month history of gradually increasing right knee pain. He says he has
always had a little difficulty with his knee over the last several years but has noted locking and catching
after an injury last year. He underwent lateral meniscectomy, and did receive considerable benefit from
that. But again, in the last 4 months he has developed increasing lateral joint pain of the right knee.
Which claim form would these professional consultation services be billed on? - ANSWER CMS-1500
In which healthcare setting is their an exception to which claim form from Medicare are reported on? -
ANSWER Ambulatory surgical center
This 16-month-old white male is noted to have increased swelling of right groin area. This would reduce
when supine. There was also an undescended testis in the right hemiscrotum. The patient presents at
this time to the same day surgery unit of Sunshine Hospital for orchiopexy and repair of hernia. Which
claim form would the surgery facility services be billed on? - ANSWER UB-04
The medical coding specialist assigns codes from which codebooks for inpatient facility coding? -
ANSWER ICD-10-CM and ICD-10-PCS
Outpatient facilities are required to report ICD-10-PCS codes to receive reimbursement for the services
rendered - ANSWER False
The chargemaster is a healthcare provider's comprehensive price list of all supplies, services, and
equipment usage fees for patient care. - ANSWER True
Charge sheets for outpatient providers usually list the most common diagnosis and procedures. -
ANSWER True
Demographic information is used to determine which departments submitted the charges for the
services rendered. - ANSWER False
This is a claim form used by hospitals, nursing facilities, in patient, and other facility providers. - ANSWER
UB-04
