NCCT missed questions
Which of the following is the most likely cause of the deposits not agreeing with the credits on the day sheet or the patient ledgers? There are duplicate cards. The bank made an error. Cash is missing. Payment is misplaced.
Payment is misplaced. Rationale: Usually at the end of the day if the deposit does not match, the payment is misplaced somewhere.
A new HIM director was recently hired at a hospital. She was advised her health insurance benefits become available in 90 days. Which of the following is correct regarding her health insurance? She will not have the option of keeping her medical insurance from her previous job. She will be able to get medical insurance benefits immediately because she is the HIM director. She will need to pay cash for medical services and be reimbursed by her new insurance company after 90 days. She will be able to keep her current medical insurance from her previous job through COBRA.
She will be able to keep her current medical insurance from her previous job through COBRA. Rationale: COBRA contains provisions giving certain former employees, retirees, spouses, former spouses, and dependent children the right to temporary continuation of health coverage at group rates.
When reviewing the charges for a patient procedure using computer assisted coding software (CAC), the insurance and coding specialist should first use the same diagnosis as the last office visit. review the chart for needed information. speak to the physician. discuss with the nurse.
review the chart for needed information. Rationale: The first step is to review the medical record for any of the necessary information. The previous diagnosis is not considered. The other two choices are steps to take if the medical record does not have the necessary information.
When is a referral from a provider required? within 24 hours of a medical procedure for Workers' Compensation patients if a patient goes to a network hospital for services when contained in the individual policy
when contained in the individual policy Rationale: HMO and POS contracts require referrals. A referral from the primary care provider is necessary to see a specialist. A referral is not required for a procedure within 24 hours due to the urgent need for care. Workers' Compensation only requires the necessary forms from the employer. Should the patient go to a network hospital, referral is not necessary due to emergency circumstances.
Which of the following modifiers is required for a return to the operating room for an unplanned related procedure or service by the same physician during the postoperative period? -78 -79 -58 -76
-78 Rationale: -78 is described as Unplanned Return to the Operative/Procedure Room by the Same Physician or Other qualified Health Care Professional Following initial Procedure for a Related Procedure During the Postoperative Period. It is the correct modifier to use in this case. -79 is unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period. -58 Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period. -76 Repeat procedure or service by the same physician or other qualified health care professional.
A patient presents for excision of a lesion on his arm. The lesion was 3 cm with 0.5 cm margins. It was a full thickness removal and the pathology proved it to be a benign lesion. The closure was simple. Which of the following is the correct CPT® code assignment? 11403 11404 11604 11424
11404 Rationale: When coding the removal of skin lesions, the codes are chosen based on whether they are benign or malignant, the location on the body, and the size. The lesion in this case was 3 cm. in diameter with .5 cm margins on each side and on the arm. The correct code is 11404, which includes lesions that are 3.1 cm to 4 cm.
The patient presents for excision of the nail and nail matrix, complete of the left great toe. Which of the following is the appropriate CPT® code assignment? 11750-TA 11762-T5 11750-T1 11762-TA
11750-TA Rationale: The 11762 code is for the reconstruction of the nailbed with a graft. This is not the procedure the provider performed. 11750 is for the excision of nail and nail matrix, partial or complete. which is the correct code. Modifier-TA is the correct modifier for the Left foot, great toe. Modifier -T1 is left foot, second digit and T5 is for the right foot, great toe.
A patient was diagnosed with cancer in both breasts and was prepped for surgery today. A simple bilateral mastectomy was performed. Which of the following is the correct CPT® code assignment? 19303-50 19303-51 19304-50 19304-51
19303-50 Rationale: 19303 is the correct code for a simple, complete. 19304 is for a subcutaneous mastectomy. The modifier 51 is used for multiple procedures and cannot be used with the primary code. The modifier 50 is used for a bilateral procedure and would be the choice to use in this case.
A patient presents for a right sided hip injection. The provider used palpitation for guidance. Which of the following is the appropriate CPT® code? 20611-RT 27096-RT 20610-RT 20605-RT
20610-RT Rationale: The procedure code for injection of a shoulder is CPT®. The HCPCS modifier -RT is used to identify which hip was treated. The other choices are 20605 it is an injection code but this is for the wrist, elbow or ankle. 20611 is a hip injection but it is with ultrasonic guidance. 27096 is for the sacroiliac joint. None of these codes would not be used.
An established patient has an office visit for the removal of five skin tags from the eye area. During the examination the patient asks the physician to evaluate minor chest pain and pressure. The physician performs an expanded history and examination with low medical decision making. Which of the following codes should be reported for today's service? 99213-25, 11200 99202-51, 11200 99214-25, 11100 99203-51, 11100
99213-25, 11200 Rationale: Two services were provided to the patient based on his need for care. The expanded history and examination was performed to evaluate the complaints of minor chest pain and pressure. The physician removed skin tags from the area around the patient's eyes. Code 99213 is correct for the office exam. Modifier -25 is added to give the message that the exam was significant and separately identifiable service at the same encounter as a procedure. The correct codes are 99213-25, and 11200 for the skin tag removal.
A 26-year-old female presented to the Emergency Department with complaint of severe headaches of 10-hour duration. An expanded problem focused history and examination were performed. The medical decision making was of moderate complexity. Which of the following is the correct Evaluation and Management code for services provided? 99282 99202 99283 99252
99283 Rationale: Code 99283 represents an emergency department visit with an expanded problem focused history and exam, with moderate complexity medical decision making. 99213 Office Visit for established patient, 99202 Office Visit for new patient and 99252 Inpatient Consultation for new or establish patient.
A 43-year-old established patient presented to office for his annual visit. The physician performed a comprehensive history and exam. The physician wrote a refill for chronic condition of Diabetes Mellitus II and Hypertension. Which of the following is the correct code assignment? 99396, Z00.00, I10, E11.9 99396, E11.9, I10 99213, E11.9, I10 99213, Z00.00, I10, E11.9
99396, Z00.00, I10, E11.9 Rationale: When a patient comes in for their annual exam or physical we use the code based on age and not the elements of a sickness office visit. The first diagnosis will be the reason for the visit, this was a wellness so we would use the Z00.00. We would then list the additional DX for the condition the prescriptions were dispensed for.
A 45-year-old patient with diabetic proliferative retinopathy is being seen today for her macular edema. Which of the following ICD-10-CM codes should be assigned? E11.3599 E11.311 E11.319 E11.3519
E11.3519 Rationale: If the type of diabetes is not specified as type I or type 2, the default is type 2. In the Alphabetic index, Diabetes/specified type/retinopathy/proliferative/with macular edema, partial code E11.351. In the Tabular List, there is a note about the need for a 7th character to specify which eye(s) are involved. In this case, 7th character 9 will be used for unspecified, code E11.3519. E11.3599 code is without macular edema, this would not be correct since macular edema is involved. E11.319 is for unspecified diabetic retinopathy without macular edema. The diagnosis is with macular edema so this is an incorrect code. E11.311 is with macular edema but with unspecified retinopathy and proliferative retinopathy is specified, so it is an incorrect code.
The patient suffers from atherosclerotic heart disease caused by plaque deposits in a grafted internal mammary artery. The patient underwent arterial bypass graft four months ago. Which of the following ICD-10-CM codes should be assigned? I25.3 I25.10 I25.810 I25.9
I25.810 Rationale: In the Alphabetic Index, the entry is Arteriosclerosis/coronary/bypass graft. This leads to I25.810. In the Tabular List, this code is described as "Atherosclerosis of coronary artery bypass graft without angina pectoris" and is the correct code. I25.3 code is for an aneurysm of the heart, which is not correct since it is not stated to be an aneurysm. Code I25.10 is for Atherosclerotic heart disease of the native coronary artery but does not include a bypass graft. I25.9 is for unspecified chronic ischemic heart disease and does not include the bypass graft.
A provider performed a right sided facet joint injection using fluoroscopic guidance. The billed codes were 64493 and 77003. An EOB was returned denying the charge of 77003. Why was this charge denied? 77003 should have been billed with a modifier -26. Imaging guidance is an inclusive component of 64493. Imaging guidance is rarely used for this procedure. 72275 should have been billed in place of 77003.
Imaging guidance is an inclusive component of 64493. Rationale: The code description states that the fluoroscopic guidance is included in the procedure and not separately billable.
A patient has not had an alcoholic drink for two years but has been diagnosed with alcoholic cirrhosis with ascites, alcohol dependence in remission. Which of the following ICD-10-CM codes should be assigned? K70.30, R18.8 K70.31, F10.21 K70.31 K70.30
K70.31, F10.21 Rationale: In the index, the main term is cirrhosis, then alcoholic, with ascites. Code K70.31 Tabular List, there is a "Use additional code" note to identify alcohol abuse and dependence, F10.-. Code F10.21 is the code for alcohol dependence, in remission. The code K70.30 would not be correct because does not account for ascites.
Eighteen hours following the delivery of her baby, a female patient who has been discharged suffers atonic postpartum hemorrhage. Which ICD-10-CM code should be assigned? O72.0 O72.1 O72.2 O72.3
O72.1 Rationale: In the Alphabetic Index, the main term is Hemorrhage, then postpartum. This directs you to hemorrhage/postpartum. There are three choices which differ in the timing of the hemorrhage. In this case, the hemorrhage started 18 hours after delivery, code O72.1, Other immediate postpartum hemorrhage, which includes atonic hemorrhage, is the correct code. Code O72.0 is for third-stage hemorrhage which doesn't represent this case and O72.3 for delayed and secondary postpartum hemorrhage which doesn't represent this case.
A patient presents to office with RUQ abdominal pain. The physician sends the patient to the hospital for HIDA scan to assess for possible cholelithiasis. Which of the following is the correct ICD-10-CM code assignment? K80.20 R10.10 R10.11 R10.9
R10.11 Rationale: For this encounter the physician only "suspects" cholelithiasis. Right upper quadrant abdominal pain is the symptom to code for this visit. In the Alphabetic Index, the main term is pain, then abdomen, and right upper quadrant, code R10.11, verified in the Tabular List and is the correct code for this visit. Code K80.20 is for cholelithiasis which has not been confirmed by the physician. R10.10 is for pain in the upper abdomen, unspecified. Code R10.9 is for unspecified abdominal pain.
A third party payer made an error while adjudicating a claim. Which of the following should the insurance and coding specialist do? Contact the insurance commissioner. Contact the patient to make payment arrangements. Resubmit the claim with an attachment explaining the error. Resubmit the claim with a correction.
Resubmit the claim with an attachment explaining the error. Rationale: Contacting the insurance commissioner is a last resort for a complaint of compliance. The patient would not be responsible for payment until the claim is processed correctly. If a claim is submitted with a correction, the insurance company will deny the claim as a duplicate. A letter explaining the error should be attached to the claim for reconsideration.
Which of the following federal regulations requires disclosure of finance charges, late fees, amount, and due dates for all payment plans? Truth in Lending Act Fair Debt Collection Practices Act Equal Credit Opportunity Act Fair and Accurate Credit Transaction Act
Truth in Lending Act Rationale: The Truth in Lending Act is a federal law designed to promote the informed use of consumer credit, by requiring disclosures about its terms and cost to standardize the manner in which costs associated with finance charges, late fees and dates of all payment plans are calculated and disclosed.
How often should the encounter form CPT® codes be updated? annually quarterly semi-annually monthly
annually Rationale: CPT® codes are updated and are effective January 1st, each year. The codes should be reviewed and updated on the encounter form prior to the effective date. The information should also be relayed to the providers to keep them updated.
Which of the following information is necessary to post payments from the RA/EOB? (Select the three (3) correct answers.) billed CPT® codes patient's date of birth patient's name date of service diagnosis codes
billed CPT® codes, patient's name, date of service Rationale: You will need to have the CPT® billed codes to make sure any payments and/or adjustments will be posted to the account. The patient name is needed to correctly identify the patient. The correct DOS on the EOB and the account for accuracy are needed. The patient DOB and the diagnosis code are not necessary for this posting
If the insurance carrier's rate of benefits is 80%, the remaining 20% is known as capitation. copayment. deductible. coinsurance.
coinsurance. Rationale: The coinsurance, is the percentage the patient must pay for the services provided. Capitation is a portion an HMO contract pays to the provider
When speaking with an insurance company representative to follow up on a denied claim, an insurance and coding specialist should have which of the following information available? (Select the three (3) correct answers). date of service physician's NPI date the claim was denied patient's mailing address patient's insurance ID number
date of service, physician's NPI, patient's insurance ID number Rationale: When speaking with an insurance company representative about a denied claim, the patient insurance ID number must be entered, along with the physician NPI and the date of service. This information will be used to identify the claim and explain the denial.
Encounter forms should be audited to ensure the payer's address and phone are current. patient's vitals are present. diagnosis is in proper ICD-10-CM format. practice information is included on each encounter.
diagnosis is in proper ICD-10-CM format. Rationale: All encounter forms need to be audited for accuracy of ICD-10-CM and CPT® codes are accurate and in the correct order. The information must match the services provided to the patient for proper billing and reimbursement.
When using the EHR to schedule a patient visit, which of the following screens should be used to complete the scheduling process? patient search clinical care correspondence accounts receivable
patient search Rationale: Patient search is always used to find the correct patient in the system for scheduling. The identity of the patient must be verified prior to answering any questions or scheduling.
When the patient calls to inquire about an account, which of the following does the insurance and coding specialist need to ask for before discussing the account? (Select the three (3) correct answers.) patient's claim number patient's address patient's date of birth patient's name patient's insurance ID number
patient's date of birth, patient's name, patient's insurance ID number Rationale: When a patient calls to discuss the account, the identity of the caller must be verified by asking the person's name, date of birth, and insurance ID number. The claim number is something that is on the EOB from the insurance company and only used by them. The address should not be used to verify identity.
Developing an insurance claim begins when the patient arrives for the appointment. after the medical encounter is completed. when the patient calls to schedule an appointment. once the charges have been entered into the computer.
when the patient calls to schedule an appointment. Rationale: Developing an insurance claim begins when the patient schedules an appointment. The insurance information is entered and verified so it will be ready when the services are provided.
When should a provider have a patient sign an ABN? when a service is excluded from coverage under Medicare. when the service(s) may be denied and prior to performing the service. when the service is covered under Part B fee schedule. prior to treating a patient who requires emergency services that might not be covered.
when the service(s) may be denied and prior to performing the service. Rationale: An Advance Beneficiary Notice (ABN) must be signed prior to performing the service. The ABN must include the service to be provided, the amount for which the patient will be responsible if the service is denied by Medicare and the reason for the possible denial.