AAMA Medical Coding and Billing 2 — Questions and Answers
Question 1: Which modifier is appended to a CPT code to indicate a procedure was performed bilaterally?
- -50 (Correct answer)
- -51
- -59
- -76
Correct answer: -50
Modifier -50 is used to indicate that a procedure was performed on both sides of the body during the same operative session.
Question 2: What does the abbreviation 'EOB' stand for in medical billing?
- Explanation of Benefits (Correct answer)
- Evidence of Billing
- Estimate of Balance
- Explanation of Balances
Correct answer: Explanation of Benefits
EOB stands for Explanation of Benefits, a document from the insurer detailing what was paid, denied, or adjusted on a claim.
Question 3: In ICD-10-CM coding, which character position indicates the encounter type (initial, subsequent, sequela)?
- 7th character (Correct answer)
- 1st character
- 4th character
- 5th character
Correct answer: 7th character
The 7th character in ICD-10-CM codes specifies the type of encounter: A (initial), D (subsequent), or S (sequela).
Question 4: A superbill is best described as which of the following?
- An itemized form listing services rendered and diagnosis codes for billing (Correct answer)
- A statement sent directly to the patient for payment
- A summary of all claims submitted to insurance in a month
- An authorization form required before elective procedures
Correct answer: An itemized form listing services rendered and diagnosis codes for billing
A superbill (charge ticket) is a preprinted form that documents services provided and corresponding procedure and diagnosis codes used to generate a claim.
Question 5: Which of the following best describes 'coordination of benefits' (COB)?
- A process determining which insurer pays first when a patient has multiple coverages (Correct answer)
- The transfer of billing responsibility from provider to patient
- A method of splitting claims between Medicare and Medicaid
- An agreement between providers to share reimbursement
Correct answer: A process determining which insurer pays first when a patient has multiple coverages
COB is the process by which two or more insurance plans determine their respective payment responsibilities to prevent overpayment.
Question 6: What is the purpose of a remittance advice (RA) in medical billing?
- To notify the provider of claim payment details and adjustments (Correct answer)
- To request additional documentation from the physician
- To inform the patient of their outstanding balance
- To authorize a referral to a specialist
Correct answer: To notify the provider of claim payment details and adjustments
A remittance advice details how each claim was processed, including amounts paid, denied, or adjusted, and is sent from the payer to the provider.
Question 7: When coding an office visit, the level of Evaluation and Management (E/M) service is primarily determined by:
- Medical decision making and/or total time on the date of encounter (Correct answer)
- The number of diagnoses listed on the superbill
- The patient's insurance plan type
- Whether the visit is for a new or established patient only
Correct answer: Medical decision making and/or total time on the date of encounter
Per current CPT guidelines, E/M office visit levels are determined by medical decision making (MDM) or total time spent on the date of the encounter.
AAMA Medical Coding and Billing 2
Which modifier is appended to a CPT code to indicate a procedure was performed bilaterally?