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AAPC CPB Chapter 6 ReviewPatient is given 15 mg of methotrexate sodium IM for rheumatoid arthritis given from 5 mg vials. What HCPCS Level II code and unit(s) is reported? a. J8610 x 6 b. J9260 c. J9250 x 5 d. J9250 x 3 d. J9250 x 3 Look in the HCPCS Level II Table of Drugs for Methotrexate Sodium, one of the routes is IM (intramuscular) directing you to code J9250. This drug is reported for 5mg. The patient received 15 mg of methotrexate. The correct way to code this injection is J925...

AAPC CPB Chapter 4 ReviewHow many chapters does ICD-10-CM contain? a. 17 b. 19 c. 22 d. 20 c. 22 What is/are the correct code(s) for a patient with type 1 diabetic neuropathy? a. E11.40 b. E90.40 c. E10.9, G62.9 d. E10.40 d. E10.40 What are the correct codes for benign hypertensive heart disease and stage 3a chronic kidney disease? a. I10, I11.9, I12.9, N18.31 b. I13.10, N18.31 c. N18.31, I13.10 d. I13.0, N18.31 b. I13.10, N18.31 Which sections of ICD-10-CM do...

AAPC CPB Chapter 7 ReviewWho were the NCCI edits originally developed to be used by? a. Commercial Carriers b. Medicare Administrative Contractors c. Self-pay patients d. Medicare beneficiaries b. Medicare Administrative Contractors The NCCI edits have column 1 and Column 2 codes and provide an indicator to determine whether a modifier is allowed to be used. Which indicator is used to tell the biller a modifier is never allowed? a. 0 b. 1 c. 9 d. A a. 0 Which of the follo...

AAPC CPB - Chapter 8 QuizPrior authorization is reported in Item 23. What other information can be reported in this area of the CMS-1500 claim form? a. Unlisted CPT® code(s) b. mammography pre-certification number c. patient identification number d. patient account number - correct answer b. mammography pre-certification number What is the type of bill code that is reported for a free standing clinic? a. 073X b. 074X c. 085X d. 075X - correct answer a. 073X When reporting proc...

AAPC CPB - Chapter 8 ExamWhich statement is TRUE regarding condition codes for the UB-04 claim form? Selected Answer: d. a. A condition code identified the department for the revenue of the procedure. b. Condition codes are listed in the order of occurrence instead of numerical order. c. Condition codes are reported only on the CMS-1500 claim form. d. A condition code is used to indicate an inpatient service is reported on an outpatient claim. - correct answer d. A condition code is used ...

AAPC CPB - Chapter 3 Quiz Listed below are examples of patient reminders for appointments. Which one is HIPAA compliant? a. "This is the obstetrical office calling to remind you of your appointment Tuesday, April 12 at 9 am for your annual exam." b. "This is Dr. Smith's office calling to remind you of your appointment Tuesday, April 12 at 9 am for your annual exam." c. "This is to confirm your appointment for your first prenatal visit with Dr. Jones. Please notify us if you are not a...

AAPC CPB - Chapter 7 QuizA patient has a breast biopsy with placement of localization device (19083) with subsequent mastectomy (19301) at the same session after the biopsy is proven to be malignant. What modifier would be used for this scenario? a. 59 b. 58 c. 25 d. 78 - correct answer b. 58 Medicare will consider Magnetic Resonance Imaging of the Brain medically reasonable and necessary when used to aid in the diagnosis of lesions of the brain and to assist in therapeutic decision mak...

AAPC CPB - Chapter 12 ReviewThe term for the set payment that the member pays to the healthcare provider on the day of service is the: a. office visit fee. b. co-insurance. c. copay. d. co-signer. - correct answer c. copay. Response Feedback: A copayment or copay is the set amount the insured member pays the healthcare provider on the day of service. Blue Cross/Blue Shield identifies the individual or employee who pays for healthcare insurance coverage as the: a. Member b. Gro...

AAPC Chapter 1 CPBA physician received office space at a reduced rate for referring patients to the hospital's outpatient physical therapy center. What Law does this violate? 1. Anti-kickback Statute 2. Stark Law 3. False Claims Act 4. Truth in Lending Act - correct answer Anti-Kickback Statute Rationale: The anti-kickback Laws states that anyone who knowingly or willing accept or offer any items or services to induce referral is a violation of the law. Federal healthcare plans incl...

AAPC CPB Ch 2 exam reviewWhat components make up the Medicare Physician Fee Schedule? Relative value units for physician work, practice expense, and professional liability insurance; the Geographical Practice Cost Index; and the conversion factor. Medicare uses the Medicare Physician Fee Schedule (MPFS) for reimbursement for physician services and other types of services. This replaced the old "customary, prevailing, and reasonable" (CPR) payment system. The MPFS is funded by Part B and is...

AAPC CPB - Chapter 8 ReviewWhich statement is TRUE regarding condition codes for the UB-04 claim form? Selected Answer: d. a. A condition code identified the department for the revenue of the procedure. b. Condition codes are listed in the order of occurrence instead of numerical order. c. Condition codes are reported only on the CMS-1500 claim form. d. A condition code is used to indicate an inpatient service is reported on an outpatient claim. - correct answer d. A condition code is use...

AAPC CPB - Chapter 1 ReviewWhat does the acronym PHI stand for? a. Patient Healthcare Information b. Patient History of Illness c. Protected Health Information d. Protected Healthcare Index - correct answer c. Protected Health Information A new radiology company opens in town. The manager calls your practice and offers to pay $20 for every Medicare patient you send to them for radiology services. What does this offer violate? a. Stark Laws b. HIPAA c. Anti-Kickback law d. Qui Tam ...

AAPC CPB - CHAPTER 3: QUESTIONSWhich of the following does NOT qualify a patient for coverage under Medicare? a. End Stage Renal Disease (ESRD) b. Age 65 or older c. Under age 65 with disabilities d. Low income individual - correct answer d. Low income individual The insurance claim process begins with: a. Patient information b. Charge entry c. Scheduling an appointment d. Submitting a claim - correct answer c. Scheduling an appointment Which of the following statements is TRUE...

CPB Final ExamEPO - correct answer ...provides benefits to subscribers who are required to receive services from network providers IDS - correct answer ...organizations of affiliated providers sites that offer joint healthcare services to subscribers HMO - correct answer ...providers comprehensive healthcare services to voluntarily enrolled members on a prepaid basis POS - correct answer ...patients can use the managed care panel of providers (paying discounted healthcare cost) or self-...

AAPC CPB - Chapter 14 Review__________ sets standards and directives to protect workers against transmission of infectious agents. a. HIPAA b. JCAHO c. NCHS d. OSHA - correct answer d. OSHA For OSHA, which employees are included as healthcare workers? I. medical staff II. maintenance staff III . housekeeping IV. food service staff V. administrative staff a. I only b. I and V c. I, III, and V d. I-V - correct answer d. I-V Which entity governs workers' compensation law? ...

AAPC CPB - Chapter 9 ReviewA ______ indicates the location or type of service provided for an inpatient and is reported with _______. a. Revenue code; four-digit code b. Revenue code; three-digit code c. CPT code; five-digit code d. MSDRG code; three-digit code - correct answer a. Revenue code; four-digit code Which of the following documentation is NOT needed for an audit? a. Encounter form b. Medical record c. Explanation of Benefits d. CMS-1500 claim form - correct answer c. Ex...

AAPC CPB - Chapter 6 Quiz A female patient is getting a right and left breast mastectomy bra with integrated form breast prosthesis. What HCPCS Level II code is reported? a. L8002 b. L8002-50 c. L8001-50 d. L8000 - correct answer a. L8002 Patient is given 15 mg of methotrexate sodium IM for rheumatoid arthritis given from 5 mg vials. What HCPCS Level II code and unit(s) is reported? a. J8610 x 6 b. J9260 c. J9250 x 5 d. J9250 x 3 - correct answer d. J9250 x 3 When 8 mg of Dila...

AAPC CPB - Chapter 12 Quiz Which type of insurance plan is a federal and state program that provides coverage to the low-income population? a. Medicare b. HMO c. Medicaid d. PPO - correct answer c. Medicaid Response Feedback: Medicaid is a joint federal and state program that provides hospital expense and medical expense coverage to the low-income population and certain aged and disabled individuals. What is the correct action when a claim has been submitted to BCBS but the provi...

AAPC CPB - Chapter 9 QuizWhen a claim has been paid, an EOB is sent to: a. the clearinghouse. b. the patient. c. the provider. d. the insurance company. - correct answer b. the patient. Cost based fee schedules are developed using which of the following: a. RBRVS methodology b. total costs of every procedure or service listed in the CPT® c. total cost of all of the procedures the physician will perform d. malpractice insurance and office operating costs - correct answer c. total ...

AAPC CPB Chapter 9 Review A patient with ABC insurance is seen on May 1st, and the claim is submitted on July 15 of the same year. Has the claim met the timely filing deadline? a. Yes. All payers have the same timely filing deadline of one year from date of service. b. No. All payers have a 30-day timely filing deadline. c. Maybe. ABC's timely filing policy should be reviewed to determine if the deadline was met. d. Maybe. Prepare an appeal letter just in case the claim is denied. ...