CPB PRACTICE EXAM A QUESTIONS
& ANSWERS(RATED A+)
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? - ANSWERworkers' 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? - ANSWERD. 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? - ANSWER66984,
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) - ANSWERVI , 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? - ANSWER99213-
25, 17110
What is the correct HCPCS Level II code for Depo-Provera (medroxyprogesterone
acetate) injection of 100 mg? - ANSWERJ1050 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. - ANSWERE10.52
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)? - ANSWERC.
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) - ANSWERA.
42820, 69436
A patient with an acute myocardial infarction is brought by ambulance to the emergency
department. The patient is taken into the cardiac catheterization lab. Angioplasty and a
stent was placed in the LAD. The patient's insurance requires preauthorization for all
surgical procedures. Which of the following statements is true for most payers? -
ANSWERBecause this was an emergency, it is acceptable to obtain authorization
following the surgery.
According to this clearinghouse rejections report, what action should be taken on the
claims for Jerry McMahon, Date of Service 11/09/XX? - ANSWER. C44.50 requires an
additional character. Review the medical record for the correct sixth character, correct
the claim in your system and re-file electronically.
Which of the following is an allowed collection policy after a patient files for bankruptcy?
- ANSWERUnpaid insurance claims for dates of service occurring after the date of the
bankruptcy can be collected.
Which statement is TRUE regarding the Fair Debt Collection Practices Act (FDCPA)? -
ANSWERCollectors are not allowed to contact debtors at odd hours.
There is a written office policy to write off patients co-insurance and copayment
amounts as a professional courtesy. Is this appropriate? - ANSWERNo, it is considered
fraud to write off the patients' responsibility for all patients
& ANSWERS(RATED A+)
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? - ANSWERworkers' 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? - ANSWERD. 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? - ANSWER66984,
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) - ANSWERVI , 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? - ANSWER99213-
25, 17110
What is the correct HCPCS Level II code for Depo-Provera (medroxyprogesterone
acetate) injection of 100 mg? - ANSWERJ1050 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. - ANSWERE10.52
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)? - ANSWERC.
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) - ANSWERA.
42820, 69436
A patient with an acute myocardial infarction is brought by ambulance to the emergency
department. The patient is taken into the cardiac catheterization lab. Angioplasty and a
stent was placed in the LAD. The patient's insurance requires preauthorization for all
surgical procedures. Which of the following statements is true for most payers? -
ANSWERBecause this was an emergency, it is acceptable to obtain authorization
following the surgery.
According to this clearinghouse rejections report, what action should be taken on the
claims for Jerry McMahon, Date of Service 11/09/XX? - ANSWER. C44.50 requires an
additional character. Review the medical record for the correct sixth character, correct
the claim in your system and re-file electronically.
Which of the following is an allowed collection policy after a patient files for bankruptcy?
- ANSWERUnpaid insurance claims for dates of service occurring after the date of the
bankruptcy can be collected.
Which statement is TRUE regarding the Fair Debt Collection Practices Act (FDCPA)? -
ANSWERCollectors are not allowed to contact debtors at odd hours.
There is a written office policy to write off patients co-insurance and copayment
amounts as a professional courtesy. Is this appropriate? - ANSWERNo, it is considered
fraud to write off the patients' responsibility for all patients
