Medical Billing chapter 7 Questions With Complete
Solutions
A claim is denied for 58100 when billed with 58150.
According to the NCCI edit, the biller should review the claim
and Correct Answers Refile with 58150 only.
Rationale: 58100 is bundled into 58150 and a modifier is not
allowed and the modifier 0 (zero) for NCCI edits indicates that a
modifier is never allowed. 58150 is the most extensive code and
should be the code billed.
A patient has a breast biopsy with placement of localization
device (19083) with subsequent mastoectomy (19301 ) at the
same session after the biopsy is proen to be malignant. what
modifier would be used for this scenario Correct Answers 58
A patient is scheduled for a laparoscopic procedure that is
converted to an open procedure after the procedure is initiated.
Which of the following would be correct coding based on CMS
NCCI edits? Correct Answers Bill only the open procedure
(most extensive).
A patient returns to the office for a planned removal of a 1.1 cm
lesion on her neck. She also complains of symptoms of an upper
respiratory infection. The physician removes the lesion as
planned (11422), and performs an expanded history and exam
with moderate medical decision making for her URI (99213).
How should this be reported? Correct Answers 11422, 99213-
25
, Rationale: In the NCCI Table, the column 2 code is included in
the column 1 code. A CCM modifier of 1 allows the use of a
modifier when the documentation supports it. This case
identifies an office visit was performed separately from the
surgical procedure. It is a minor procedure. Modifier 25 is
appropriate.
A patient undergoes aspiration of multiple breast cysts. Two
cysts were aspirated in the left breast and 3 cysts were aspirated
in the right breast. Use the following medically unlikely edits
(MUE) table to determine if the claim is correct.
Claim is billed with 19000 x 5, 19001 X 5: Correct Answers
The claim should be billed as 19000-50, 19001 X 3.
According to the NCCI table, when an excision of a pilonidal
cyst or sinus, simple (11770) is performed and a simple repair
(12002) is performed at a different location, how should this be
reported for a commercial carrier using the NCCI edits? Correct
Answers 11770, 12002-59
An E/M service that is performed during a post-operative period,
but is not related to the surgical procedure that was performed,
can be billed with which modifier? Correct Answers 24
Based on NCCI edits, when a procedure is bundled and has a
CCM indicator of 0 - which of the following Modifiers is
allowed? Correct Answers Modifiers are not allowed
Solutions
A claim is denied for 58100 when billed with 58150.
According to the NCCI edit, the biller should review the claim
and Correct Answers Refile with 58150 only.
Rationale: 58100 is bundled into 58150 and a modifier is not
allowed and the modifier 0 (zero) for NCCI edits indicates that a
modifier is never allowed. 58150 is the most extensive code and
should be the code billed.
A patient has a breast biopsy with placement of localization
device (19083) with subsequent mastoectomy (19301 ) at the
same session after the biopsy is proen to be malignant. what
modifier would be used for this scenario Correct Answers 58
A patient is scheduled for a laparoscopic procedure that is
converted to an open procedure after the procedure is initiated.
Which of the following would be correct coding based on CMS
NCCI edits? Correct Answers Bill only the open procedure
(most extensive).
A patient returns to the office for a planned removal of a 1.1 cm
lesion on her neck. She also complains of symptoms of an upper
respiratory infection. The physician removes the lesion as
planned (11422), and performs an expanded history and exam
with moderate medical decision making for her URI (99213).
How should this be reported? Correct Answers 11422, 99213-
25
, Rationale: In the NCCI Table, the column 2 code is included in
the column 1 code. A CCM modifier of 1 allows the use of a
modifier when the documentation supports it. This case
identifies an office visit was performed separately from the
surgical procedure. It is a minor procedure. Modifier 25 is
appropriate.
A patient undergoes aspiration of multiple breast cysts. Two
cysts were aspirated in the left breast and 3 cysts were aspirated
in the right breast. Use the following medically unlikely edits
(MUE) table to determine if the claim is correct.
Claim is billed with 19000 x 5, 19001 X 5: Correct Answers
The claim should be billed as 19000-50, 19001 X 3.
According to the NCCI table, when an excision of a pilonidal
cyst or sinus, simple (11770) is performed and a simple repair
(12002) is performed at a different location, how should this be
reported for a commercial carrier using the NCCI edits? Correct
Answers 11770, 12002-59
An E/M service that is performed during a post-operative period,
but is not related to the surgical procedure that was performed,
can be billed with which modifier? Correct Answers 24
Based on NCCI edits, when a procedure is bundled and has a
CCM indicator of 0 - which of the following Modifiers is
allowed? Correct Answers Modifiers are not allowed
