CMAA Billing, Coding, and Claims 4 — Questions and Answers
Question 1: A claim is returned to the medical office as 'unprocessable' due to a missing NPI. Which field on the CMS-1500 form contains the rendering provider's NPI?
- Box 24J (Correct answer)
- Box 33a
- Box 17b
- Box 21
Correct answer: Box 24J
Box 24J on the CMS-1500 form is where the rendering provider's NPI is entered for each service line.
Question 2: Which modifier is appended to a CPT code to indicate a service was performed by a physician assistant under the supervision of a physician?
- -80
- -AS (Correct answer)
- -SA
- -GC
Correct answer: -AS
Modifier -AS identifies services performed by a physician assistant, nurse practitioner, or clinical nurse specialist assisting at surgery.
Question 3: A patient's EOB shows a 'crossover claim' notation. What does this mean?
- The claim was denied and resubmitted
- The claim was forwarded from Medicare to a secondary payer automatically (Correct answer)
- The patient has two primary insurances
- The claim requires additional documentation
Correct answer: The claim was forwarded from Medicare to a secondary payer automatically
A crossover claim is automatically forwarded by Medicare to a secondary insurer (such as Medicaid) after Medicare processes it.
Question 4: Under the ICD-10-CM guidelines, when coding an encounter for a patient with a personal history of colon cancer who is now in remission, which code category is used?
- C18
- Z85.038
- Z85.3 (Correct answer)
- D12
Correct answer: Z85.3
Z85.3 (Personal history of malignant neoplasm of large intestine) is used when the cancer is no longer active but the patient has a history of it.
Question 5: Which of the following is the correct order for entering diagnosis codes on a claim when a patient has multiple conditions?
- Alphabetical by condition name
- Chronic conditions always listed first
- Principal/primary diagnosis first, then additional diagnoses (Correct answer)
- Most expensive condition first
Correct answer: Principal/primary diagnosis first, then additional diagnoses
The principal or primary diagnosis (the condition chiefly responsible for the visit) is always listed first, followed by secondary diagnoses.
Question 6: A claim for an office visit is denied with code CO-4 (Inconsistent with the modifier). What is the most likely issue?
- The modifier does not affect reimbursement for this service
- The modifier used is not appropriate for the CPT code billed (Correct answer)
- The claim was submitted to the wrong payer
- The patient's deductible has not been met
Correct answer: The modifier used is not appropriate for the CPT code billed
Denial code CO-4 means the modifier billed is inconsistent with or inappropriate for the procedure code submitted.
Question 7: What is the purpose of the Coordination of Benefits (COB) clause in health insurance?
- To allow patients to choose their primary insurer each year
- To prevent duplicate payments when a patient has multiple insurance plans (Correct answer)
- To determine which diagnoses are covered under each plan
- To calculate patient copayments across all plans
Correct answer: To prevent duplicate payments when a patient has multiple insurance plans
COB provisions ensure that total payments from multiple insurers do not exceed the actual cost of services, preventing overpayment.
CMAA Billing, Coding, and Claims 4
A claim is returned to the medical office as 'unprocessable' due to a missing NPI.
Which field on the CMS-1500 form contains the rendering provider's NPI?