Medical Coding and Billing Flashcards

Which modifier is appended to a CPT code to indicate a procedure was performed bilaterally?

Answer: -50

Modifier -50 is used to indicate that a procedure was performed on both sides of the body during the same operative session.

What does the abbreviation 'EOB' stand for in medical billing?

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.

In ICD-10-CM coding, which character position indicates the encounter type (initial, subsequent, sequela)?

Answer: 7th character

The 7th character in ICD-10-CM codes specifies the type of encounter: A (initial), D (subsequent), or S (sequela).

A superbill is best described as which of the following?

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.

Which of the following best describes 'coordination of benefits' (COB)?

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.

What is the purpose of a remittance advice (RA) in medical billing?

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.

When coding an office visit, the level of Evaluation and Management (E/M) service is primarily determined by:

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.