Medical Billing and Coding Basics Flashcards
7 cards from real CCMA practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 7 Medical Billing and Coding Basics flashcards as text
Which modifier is appended to a CPT code to indicate that a procedure was performed on the left side of the body?
Answer: -LT
Modifier -LT (Left Side) is used to identify procedures performed on the left side of the body.
What is a 'clean claim' in medical billing?
Answer: A claim submitted without errors that can be processed and paid without additional information
A clean claim contains all required information and no errors, allowing the payer to adjudicate it without requesting additional data.
The Relative Value Unit (RVU) system used in Medicare's RBRVS fee schedule consists of which three components?
Answer: Work, practice expense, and malpractice
RVUs are composed of physician work, practice expense, and malpractice expense components, each adjusted by a geographic factor.
When a provider does not have a contract with a patient's insurance plan, the provider is considered:
Answer: Non-participating (out-of-network)
A non-participating or out-of-network provider has no contractual agreement with the payer, often resulting in lower reimbursement and higher patient cost-sharing.
Which of the following best describes 'upcoding' in medical billing?
Answer: Assigning a higher-level code than the service documented to increase reimbursement
Upcoding is the fraudulent practice of billing for a higher-level service than was actually provided or documented.
A patient is seen for an office visit and also receives an injection during the same encounter. The provider bills both services. What modifier may be needed on the injection code?
Answer: -59 on the injection code
Modifier -59 (Distinct Procedural Service) on the injection code indicates it is a separate and distinct service from the E/M visit.
What is the function of the National Provider Identifier (NPI) in medical billing?
Answer: It is a unique 10-digit number assigned to healthcare providers for use in standard transactions
The NPI is a unique HIPAA-mandated 10-digit identifier assigned to each healthcare provider for use in electronic billing and administrative transactions.