AAPC Chapter 14 Practical Application

Use CPB Chapter 14_Case 1.pdf to answer questions 1 & 2. After review of the information provided, are there any errors on the claim form? If so, which elements are incorrect? I. Insured's name II. Secondary insurance III. Primary insurance policy number IV. Date of birth V. Date of injury VI. Relationship to the insured VII. Place of service VIII. CPT codes IX. Modifier use X. Diagnosis code A. I, III, VI, and X B. I, II, VI, and VII C. III, IV, V, VIII, and IX D. None of the above.

A. I, III, VI, and X Response Feedback: Rationale: For Workers' Compensation claims, the insured is the employer. The relationship to the insured should be other and the insured's name and address should be the employer's name and address. Primary insurance policy number is incorrect. In addition, because this is the first visit, a place of occurrence, activity, and status code should be reported.

Which statement is TRUE regarding CPB Chapter 14_Case 3.pdf? A. The Workers' Compensation carrier will process this claim as is. B. CPT code 71010 is not valid for 2019. C. The patient should be listed as the insured. D. 7th character A should be appended to J60.

B. CPT code 71010 is not valid for 2019. Response Feedback: Review the medical record as a 7th character is required for appropriate coding. Code should be reported with 71045.

Use CPB Chapter 14_Case 2.pdf to answer questions 3 & 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. Secondary insurance III. Primary insurance policy number IV. Date of birth V. Date of injury VI. Relationship to the insured VII. Dates patient is unable to work VIII. CPT codes IX. Modifier use X. Diagnosis code A. I, VI, and X B. VII, VIII, IX, and X C. II, III, III, IV, V, and VI D. None of the above.

B. VII, VIII, IX, and X Response Feedback: The diagnosis requires another character to be complete. The diagnoses codes indicating the cause, place of occurrence, activity, and status should also be reported. The CPT code for the injection is missing. Because there was an E/M visit and an injection reported together, modifier 25 is also reported. The dates the patient is unable to work indicates the day of the accident only but the medical record states the patient is unable to work for three days.

Which statement is TRUE regarding CPB Chapter 14_Case 1.pdf? A. The Workers' Compensation carrier will process this claim as is. B. The place of service should be 11. C. AAPC National Bank should be listed as the insured. D. The CPT code should be replaced and the claim refiled.

C. AAPC National Bank should be listed as the insured. Response Feedback: For Workers' Compensation claims, the insured is the employer. The relationship to the insured should be other and the insured's name and address should be the employer's name and address.

Use CPB Chapter 14_Case 3.pdf to answer questions 5 & 6. After review of the information provided, are there any errors on the claim form? If so, which elements are incorrect? I. Primary insurance II. Secondary insurance III. Primary insurance policy number IV. Date of birth V. Date of injury VI. Relationship to the insured VII. Dates patient is unable to work VIII. CPT codes IX. Modifier use X. Diagnosis code A. I, II, VI, and X B. VII, III, IV, and V C. VIII and IX D. None of the above.

C. VIII and IX Response Feedback: 71010 is a deleted code. Modifier 25 is only reported on E/M codes.

Which statement is TRUE regarding CPB Chapter 14_Case 2.pdf? A. The Workers' Compensation carrier will process this claim as is. B. The place of service should be 11. C. The patient should be listed as the insured. D. 7th character A should be appended to T63.441.

D. 7th character A should be appended to T63.441. Response Feedback: Review the medical record as a 7th character is required for appropriate coding. Code should be shown as T63.441A.