CDEO STUDY GUIDE CHAPTER 5
In risk adjustment, CMS adjusts risk scores to maintain an average risk score of 1.0.
What is this called?
A. Conversion factor
B. Contractual adjustment
C. Risk adjustment factor
D. Normalization adjustment - Correct Answers -D. Normalization adjustment
The purpose of the FFS normalization adjustment is so that CMS payments are based
on a population with an average risk score of 1.0. This is the national average. Annually,
Medicare normalizes the risk scores to maintain an average risk score of 1.0. A 1.0 risk
score represents average annual Medicare costs for an individual. A risk score higher
than 1.0 means the individual is likely to incur costs higher than average. A risk score
less than 1.0 means the individual will incur costs less than average.
Which statement is TRUE regarding modifier 25?
A. Modifier 25 is appended to a surgical procedute to bypass NCCI edits
B. The payment is increased by 25% when modifier 25 is appended to an office visit
C. When an office visit is performed that is separately identifiable from a minor surgery,
modifier 25 is appended to the office visit
D. Modifier 25 is only appended to surgical procedure - Correct Answers -C. When an
office visit is performed that is separately identifiable from a minor surgery, modifier 25
is appended to the office visit
According to CMS, an E/M service that is separate and distinct from a minor procedure
or endoscopic procedure with a 0 or 10-day postoperative period and no pre-operative
period are reportable with modifier 25 appended to the E/M.
What type of information should a documentation specialist look for when modifier 22 is
appended to a surgical procedure because the patient is obese?
A. Documentation of the BMI is sufficient
B. Documentation should indicate the surgical procedure was complicated enough to
require a surgical assistant
C. Documentation should indicate how much took, or what work was above and beyond
the normal work because the patient was obese
D. There is no need for documentation to support the obesity; the diagnosis is
supportive enough - Correct Answers -C. Documentation should indicate how much
In risk adjustment, CMS adjusts risk scores to maintain an average risk score of 1.0.
What is this called?
A. Conversion factor
B. Contractual adjustment
C. Risk adjustment factor
D. Normalization adjustment - Correct Answers -D. Normalization adjustment
The purpose of the FFS normalization adjustment is so that CMS payments are based
on a population with an average risk score of 1.0. This is the national average. Annually,
Medicare normalizes the risk scores to maintain an average risk score of 1.0. A 1.0 risk
score represents average annual Medicare costs for an individual. A risk score higher
than 1.0 means the individual is likely to incur costs higher than average. A risk score
less than 1.0 means the individual will incur costs less than average.
Which statement is TRUE regarding modifier 25?
A. Modifier 25 is appended to a surgical procedute to bypass NCCI edits
B. The payment is increased by 25% when modifier 25 is appended to an office visit
C. When an office visit is performed that is separately identifiable from a minor surgery,
modifier 25 is appended to the office visit
D. Modifier 25 is only appended to surgical procedure - Correct Answers -C. When an
office visit is performed that is separately identifiable from a minor surgery, modifier 25
is appended to the office visit
According to CMS, an E/M service that is separate and distinct from a minor procedure
or endoscopic procedure with a 0 or 10-day postoperative period and no pre-operative
period are reportable with modifier 25 appended to the E/M.
What type of information should a documentation specialist look for when modifier 22 is
appended to a surgical procedure because the patient is obese?
A. Documentation of the BMI is sufficient
B. Documentation should indicate the surgical procedure was complicated enough to
require a surgical assistant
C. Documentation should indicate how much took, or what work was above and beyond
the normal work because the patient was obese
D. There is no need for documentation to support the obesity; the diagnosis is
supportive enough - Correct Answers -C. Documentation should indicate how much
