Medical Coding and Billing Flashcards

Which HCPCS Level II code category is used for durable medical equipment (DME)?

Answer: E codes

HCPCS Level II E codes are assigned to durable medical equipment such as wheelchairs, walkers, and hospital beds.

A claim is submitted with an incorrect patient date of birth, causing a denial. This is an example of which type of billing error?

Answer: Demographic error

A demographic error involves incorrect patient information such as name, date of birth, or insurance ID that causes a claim denial.

What is the global surgical package in CPT coding?

Answer: A bundle of services included in a surgical fee, covering preoperative, intraoperative, and postoperative care

The global surgical package bundles all services related to a surgery—pre-op, the procedure itself, and post-op follow-up—into one reimbursement.

Which of the following describes 'upcoding'?

Answer: Billing a higher-level service than was actually performed

Upcoding is fraud that involves reporting a higher-level or more complex service than was actually provided to receive greater reimbursement.

In the CMS-1500 claim form, Box 21 is used to report:

Answer: Diagnosis codes

Box 21 on the CMS-1500 form is where the provider enters up to 12 ICD diagnosis codes that justify the medical necessity of the services billed.

A patient covered by both Medicare and Medicaid is known as a:

Answer: Dual eligible

A dual eligible patient qualifies for both Medicare (primary) and Medicaid (secondary), which may cover Medicare cost-sharing amounts.

Which modifier indicates that a procedure or service was distinct or independent from other services performed on the same day?

Answer: -59

Modifier -59 identifies procedures or services not normally reported together that are distinct and independent from each other on the same day.