Billing, Coding, and Claims Flashcards
7 cards from real CMAA practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 7 Billing, Coding, and Claims flashcards as text
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?
Answer: Box 24J
Box 24J on the CMS-1500 form is where the rendering provider's NPI is entered for each service line.
Which modifier is appended to a CPT code to indicate a service was performed by a physician assistant under the supervision of a physician?
Answer: -AS
Modifier -AS identifies services performed by a physician assistant, nurse practitioner, or clinical nurse specialist assisting at surgery.
A patient's EOB shows a 'crossover claim' notation. What does this mean?
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.
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?
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Z85.3 (Personal history of malignant neoplasm of large intestine) is used when the cancer is no longer active but the patient has a history of it.
Which of the following is the correct order for entering diagnosis codes on a claim when a patient has multiple conditions?
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.
A claim for an office visit is denied with code CO-4 (Inconsistent with the modifier). What is the most likely issue?
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.
What is the purpose of the Coordination of Benefits (COB) clause in health insurance?
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.