AAPC CPB - Chapter 8 Practical Application Question and answers 2023

AAPC CPB - Chapter 8 Practical Application Question and answers 2023Using the information in CPB Chapter 8 Case 1 to answer questions 1 and 2. After review of the information provided, are there any errors on the claim form? If so, which elements are incorrect? I Date of birth II Date of service III Primary insurance policy number IV Primary insurance group number V Secondary insurance policy number VI Secondary insurance group number VII Place of service VIII Billing provider IX Provider signature X Work related a. I, III, VII, and IX b. I and X c. V, VII, and VI d. There are no errors on this claim. b. I and X Rationale: The date of birth is not in the correct format and the birth year is incorrect. The date of birth is shown in Item 3 on the claim form. Enter the patient's 8-digit birth date (MM|DD|CCYY). The claim form states the injury is work related however based on the documentation this injury was not due to work. Using the information in CPB Chapter 8 Case 1, answer the following question. What should be done to correct the claim? I Correct the formatting of Item 3 on the claim. II Add the patient's secondary insurance information on the claim. III Enter the ordering provider's name and NPI. IV Review the ICD-10-CM codebook and the medical record to determine the correct diagnosis code. V Review the medical record to verify an X-Ray was performed. a. II and V b. I, II, and III c. I and IV d. There are no errors on this claim. c. I and IV Rationale: Item 3 needs to be formatted to include a zero before the month and the day so the format of the date of birth is correct and change the year to 1973 instead of 1963. Because the ICD-10-CM code is truncated, the biller will need to view the codebook to determine how many characters are needed and medical record is required to complete applying those characters. Using the information in CPB Chapter 8 Case 2 to answer question 3. After review of the information provided, are there any errors on the claim form? If so, which elements are incorrect? 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 IX Units of service X Service Facility Location Information a. III, IV, and X b. III and VIII c. VIII, IV and X d. None of the above b. III and VIII Rationale: All elements of the claim are correct except: III - relationship to the insured is incorrect. Spouse is checked, where self needs to be checked. VIII - the diagnosis code needs another character. When the code is referenced in the Tabular List, a 7th character icon indicates the need for a 7th character. The A for initial visit is added to the end of the code. Using the information in CPB Chapter 8 Case 3 to answer question 4. After review of the information provided, are there any errors on the claim form? If so, which elements are incorrect? I Primary Insurance II Primary insurance ID number III Relationship to the insured IV Birthdate of insured V Provider NPI VI CPT code(s) VII Modifier VIII Diagnosis code IX Units of service X Service Facility Location Information a. II, III, VII, and X b. I, II, and III c. III and IV d. None of the above c. III and IV Rationale: All of the elements are correct except -III - the relationship to the insured. The box checked is self, when the spouse is the insured IV - Birthdate of the insured - this has been left blank and the birthdate of the insured must always be included. Using the information in CPB Chapter 8 Case 4 to answer question 5. After review of the information provided, are there any errors on the claim form? If so, which elements are incorrect? I Primary Insurance II Primary insurance ID number III Relationship to the insured IV Birthdate of insured V Provider NPI VI CPT code(s) VII Modifier VIII Diagnosis code IX Units of service X Service Facility Location Information a. I, IV, V and VIII b. II, V, and VI c. II and V d. None of the above a. I, IV, V and VIII Rationale: All of the elements are correct except -I - Primary Insurance. The primary insurance listed on the claim is Medhealth. It should be Health Systems. IV - There is no secondary insurance listed on the claim form. V - Secondary insurance ID number. Because there is no secondary insurance listed, there is also no insurance ID listed. VIII - Diagnosis code(s). The diagnosis code is incorrect. Enter the ICD-10-CM codes without decimals in proper code sequence. For example, code F17.219 should be reported as F17219 on the claim form Use the information in CPB Chapter 8 Case 5 to answer questions 6 and 7. After review of the information provided, are there any errors on the claim form? If so, which elements are incorrect? I Date of Birth II Date of service III Primary insurance policy number IV Secondary insurance policy V Secondary insurance policy number VI Secondary insurance group number VII Place of service VIII Billing provider IX Provider signature X Diagnosis code a. I and III b. I and X c. V, VII, and VI d. There are no errors on this claim. a. I and III Rationale: The patient's date of birth is not entered on the claim. The primary insurance policy number in item 1(a) does not match what is given in the documentation for the case. Use the information in CPB Chapter 8 Case 5 to answer the following question. What should be done to correct the claim? I Complete Item 3. II Add the patient's secondary insurance information on the claim. III Enter the ordering provider's name and NPI. IV Review the ICD-10-CM codebook and the medical record to determine the correct diagnosis code. a. I b. III c. I and III d. II and IV a. I Rationale: Item 3 needs to be completed; enter the patient's 8-digit birth date (MM|DD|CCYY).