Medical Billing and Coding Flashcards

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

Answer: -50

Modifier -50 indicates a procedure was performed on both sides of the body during the same operative session.

What is the purpose of an Explanation of Benefits (EOB)?

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.

In ICD-10-CM coding, which category of codes is used for external causes of morbidity?

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.

A patient is seen for a sprained ankle and a follow-up on hypertension in the same visit. How should the diagnoses be sequenced?

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.

What does the acronym HIPAA stand for?

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.

Which claim form is used by physicians and outpatient facilities to bill Medicare and most commercial insurers?

Answer: CMS-1500

The CMS-1500 (also called HCFA-1500) is the standard claim form used by professional providers for outpatient billing.

What is a capitation payment model in medical billing?

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.