CMA Medical Billing and Coding 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 indicates a procedure was performed on both sides of the body during the same operative session.
Question 2: What is the purpose of an Explanation of Benefits (EOB)?
- It is a bill sent to the patient for services rendered
- It explains how the insurer processed a claim and what was paid or denied (Correct answer)
- It authorizes a provider to perform a procedure
- It lists all diagnoses made during a visit
Correct answer: It explains how the insurer processed a claim and what was paid or denied
An EOB is a document from the insurer detailing how a claim was adjudicated, including amounts paid, denied, and patient responsibility.
Question 3: In ICD-10-CM coding, which category of codes is used for external causes of morbidity?
- Z codes
- V, W, X, Y codes (Correct answer)
- S and T codes
- G codes
Correct answer: V, W, X, Y codes
V, W, X, and Y codes in ICD-10-CM classify external causes of injury, such as accidents, falls, and assaults.
Question 4: A patient is seen for a sprained ankle and a follow-up on hypertension in the same visit. How should the diagnoses be sequenced?
- Hypertension always listed first as a chronic condition
- The condition chiefly responsible for the visit listed first (Correct answer)
- Alphabetical order by condition name
- The most expensive condition listed first
Correct answer: The condition chiefly responsible for the visit listed first
The principal diagnosis or the condition chiefly responsible for the visit should be listed first according to ICD-10-CM guidelines.
Question 5: What does the acronym HIPAA stand for?
- Health Insurance Portability and Accountability Act (Correct answer)
- Health Information Privacy and Access Authorization
- Hospital Insurance Procedure and Administration Act
- Healthcare Integrated Patient Assistance Act
Correct answer: Health Insurance Portability and Accountability Act
HIPAA stands for the Health Insurance Portability and Accountability Act of 1996, which governs privacy and security of health information.
Question 6: Which claim form is used by physicians and outpatient facilities to bill Medicare and most commercial insurers?
- UB-04
- CMS-1500 (Correct answer)
- ADA Dental Claim Form
- CMS-1450
Correct answer: CMS-1500
The CMS-1500 (also called HCFA-1500) is the standard claim form used by professional providers for outpatient billing.
Question 7: What is a capitation payment model in medical billing?
- A fee paid per individual procedure performed
- A fixed per-member-per-month payment regardless of services used (Correct answer)
- Reimbursement based on the provider's usual charges
- Payment determined by a government fee schedule
Correct answer: A fixed per-member-per-month payment regardless of services used
Capitation is a payment arrangement where a provider receives a fixed monthly fee per enrolled patient regardless of how many services are rendered.
CMA Medical Billing and Coding 2
Which modifier is appended to a CPT code to indicate a procedure was performed bilaterally?