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MICB State Practice
Practice Exam for Medical Coding and Billing
| Question | Answer |
|---|---|
| Which of the following forms provides information from the Managed Care Organization that paid on the claim? | EOB |
| When is a referral from a provider required? | When contained in the individual policy. |
| Which of the following should an insurance and coding specialist do when checking for completion of a new patient's registration form? (select the three correct answers) | Check that demographics are complete. Make sure that the patient's name matches the insurance card. Make sure the registration form is signed and dated. |
| When the patient calls to inquire about an account, which of the following does the insurance and coding specialist need to ask for before discussing the account? (select the three correct answers) | Patient's date of birth. Patient's name. Patient's insurance ID number. |
| The patient needs to have a tubal litigation performed. Which of the following is needed in order for the third party payer to cover the procedure? | Pre-certification |
| The patient is sent a statement for an office visit. The total amount of the bill is $100.00 and this amount must be paid before the insurance company will pay on the claim. Which of the following is this called? | Deductible |
| A patient arrives at the physician's office and the specialist notes the patient has a HMO plan. After the appointment, the physician wants the patient to meet with a general surgeon. Which of the following should be the next step for the specialist? | Request a referral to a network surgeon. |
| When using the EHR to schedule a patient visit, which of the following screens should be used to complete the scheduling process? | Patient Search |
| A third party payer made an error while adjudicating a claim. Which of the following should the insurance and coding specialist do? | Resubmit the claim with an attachment explaining the error. |
| A patient has called to schedule an appointment for an office visit tomorrow. It is discovered during the scheduling process that the insurance policy on file has been cancelled. Which of the following should the insuance and coding specialis do next? | Advise the patient to bring current insurance information to the appointment. |
| Which of the following refers to documentation obtained from an insurance company that allows patients to receive treatment using their benefits? | Preauthorization |
| When using an EHR system to enter CPT codes on a CMS 1500 claim form for electronic submission, which of the following should be entered on the claim form first? | The most resource-intensive procedure or service |
| A Medicare patient has an 80/20 plan. The amount was $300.00. The amount allowed was $100.00. Which of the following is the patient's coinsurance? | $20 |
| Which of the following Medicare part covers inpatient hospital stays? | Part A |
| Collections agencies are regulated by the | Fair Debt Collections Practices Act. |
| When should a provider have a patient sign an ABN? | When the items may be denied and prior to performing the service. |
| Which of the following patient information is needed to work out payment plans? (select the three correct answers) | Poverty level. Amount of the bill. Number of dependents. |
| Which of the following financial reports produces a quarterly review of any dollar amount a patient still owes after all insurance carriers claim payments have been received? | Aging. |
| An insurance and coding specialist is reviewing Appendix B in the CPT book. Which of the following tasks is she most likely performing? | Checking the renumbered codes. |
| Which of the following must be verified to process a credit card transaction? (select the three correct answers) | Account number. Credit card number. Security Code. |
| Which of the following reports is used to follow up on outstanding claims to third party payers? | Aging. |
| Which of the following information is necessary to post payments from the RA/EOB? (select the three correct answers) | Billed CPT codes. Patient's name. Date of service. |
| A provider is paid the same rate per patient whether or not they provide services and no matter which services were provided. This payment is known as | Capitation. |
| An established patient is being seen by the physician today. The patient owes $25.00 for the visit. The amount collected for the office visit is called the | Copayment. |
| When a document is changed in an EHR, the original documentation is | Hidden, |
| Providers may receive payment directly from the insurance carrier by accepting an | Assignment of Benefits. |
| Which of the following fees posted to the patient's account is an example of "usual, customary, and reasonable"? | Allowed amount. |
| A patient was seen in the office. Charges were recorded and submitted to the patient's insurance, and an EOB was received y the office with a payment of $70.89. These transactions should be recorded in the | Patient ledger. |
| Which of the following is an appropriate way to open the discussion when explaining practice fees to a patient? | "Do you have any questions about the cost of today's visit? I will be glad to answer them." |
| in order to have claims paid as quickly as possible, the insurance specialist must be familiar with which of the following? | Payer's claim processing procedures. |
| When posting transactions for electronic claims submission, it is necessary to enter which of the following items onto the claim? | Physician's office fee. |
| When a capitation account is applied to the ledger it is also known as a | Monthly prepayment amount. |
| HIPAA allows a health care provider to communicate with a patient's family, friends, or other persons who are involved in the patient's care regarding their mental health status providing | The patient does not object. |
| Which of the following are necessary to complete the CMS 1500 form? (select the three correct answers) | Diagnosis and CPT codes. Physician information. Demographic information. |
| A claim submitted with all the necessary and accurate information so that it can be processed and paid is called a | Clean claim. |
| A coding specialist is reviewing a patient's encounter form that is documented in the medical record prior to completing a CMS 1500 form. She notices that the physician upcoded the encounter form. The specialist has the ethical obligation to first | Query the physician. |
| When there is a professional discount awarded to a patient's account the insurance and coding specialist should post the discounted amount under the | Adjustment column. |
| When following up on a denied claim, an insurance and coding specialist should have which of the following information available when speaking with the insurance company? (select the three correct answers) | Patient's claim number. Physician's NPL. Patient's insurance ID number. |
| Which of the following defines the maximum time that a debt can be collected from the time it was incurred or became due? | Statute of limitations. |
| An insurance and coding specialist is billing the insurance company of a 66-year old woman, who has Medicare and is covered under her husband's private insurance. Which of the following should be billed first? | The husband's insurance. |
| When receiving the charges for a patient's procedure using computer assisted coding software (CAC), the insurance and coding specialist should first | Review the chart for needed information. |
| Which of the following is the most likely cause of the deposits not agreeing with the credits on the day sheet or the patient ledgers? | Payment is misplaced. |
| The most effective method to manage patient statements and other financial invoices as well as avoid payment delays is to | Collect fees at the time of service. |
| A new patient comes to the window to find out what the abbreviation LMP on her form means. The insurance and coding specialist blurts out the answer for the office to hear. Which of the following standards has the specialist violated? | HIPAA |
| When posting an insurance payment via an EOB, the amount that is considered contractual is the | Insurance allowed amount |
| A new HIM director was recently hired at a hospital. She was advised her health insurance benefits become available in 90 days. Which of the following is correct regarding her health insurance? | She will be able to keep her current medical insurance from her previous job through COBRA. |
| Developing an insurance claim begins | When the patient calls to schedule an appointment. |
| Based on the CMS manual system, when updating or maintaining the billing code database, which of the following does the "R" denote? | Revised |
| Which of the following must a patient sign prior to an insurance claim being processed? | An authorization to release form. |
| Which of the following regulations prohibits the submission of a fraudulent claim or making a false statement or representation in connection with a claim? | Federal False Claims Act |
| Which of the following are violations of the Stark Law? (select the two correct answers) | Accepting gifts in place of payment from patients. Referring patients to facilities where the provider has a financial interest. |
| Which of the following forms must be transmitted to obtain reimbursement following a physician's office visit for a patient with active Medicaid coverage? | CMS-1500 |
| Which of the following are needed to submit a prior authorization request for medical equipment? | ICD-CM and HCPCS codes. |
| Which of the following is the correct procedure for keeping a Workers' Compensation patient's financial and health records when the same physician is also seeing the patient as a private patient? | Separate financial and health records must be used. |
| If the insurance and coding specialist suspects Medicare fraud she should contact the | OIG |
| The Fair Debt Collection Practices Act restricts debt collectors from engaging in conduct that includes | Calling before 8:00 AM or after 9:00 PM, unless permission is given. |
| When the patient has signed the assignment of benefits form, the payment for services should be sent to the provider unless the provider is | Out of network. |
| If a married couple is covered under both of the spouses' health insurance and the husband wishes to schedule an appointment for an annual exam, he should call his primary care provider and | Schedule an appointment using both his insurance benefits and his wife's insurance benefits. |
| A 26-year old female presented to the ED with complaint of severe headache of 10-hour duration. An expanded problem focused history and examination were performed. The MDM was of moderate complexity. Which of the following is the correct E/M code for the | 99283 |
| A patient presents to the ED with multiple stab wounds to the arms and chest. On examination there are 3 deep lacerations to the arms measuring 1.2 cm, 1.4 cm and 2.1 cm requiring complex closure and 2 superficial wounds measuring 1.3 cm and 2.4 cm reauir | 13121, 12032-59 |
| An established patient comes into the ENT office where the physician performs an irrigation on the right ear. Which of the following CPT codes should be assigned? | 99213 |
| The patient presents for excision of the nail and nail matrix, complete of the left great toe. Which of the following is the appropriate CPT code assignment? | 11750-TA |
| The patient returned to the operative suite 10 days postoperative for an I&D due to a postoperative infection. The final lab results discover the organism is pseudomonas mallei. Which of the following is the appropriate ICD-10-CM coding? | T81.4XXA, A24.0 |
| The patient suffers from atherosclerotic heart disease caused by plaque deposits in a grafted internal mammary artery. The patient underwent arterial bypass graft four months ago. Which of the following ICD-10-CM codes should be assigned? | I25.810 |
| A physician uses cryotherapy for correction of trychiasis. Which of the following CPT codes should be assigned? | 67825 |
| A patient with low back pain. The physician ordered an MRI and discovered the patient has L5/S1 spondylolisthesis. Which of the following is the correct ICD-10-CM code assignment? | M43.17 |
| A 32-year old patient required an urgent vaginal hysterectomy following delivery of her third child. Which of the following anesthesia codes should be assigned? | 01962-P1 |
| A patient presents for a colonoscopy. The physician removes a polyp in the transverse colon by hot biopsy forceps. A second polyp in the sigmoid colon was removed by snare technique. Which of the following is the correct CPT code assignment? | 45385, 45384-59 |
| A patient is seen in the office for a candidal paronychia nail abcess was incised and drained. Which of the following is the correct CPT code assignment | 10060 |
| A patient has a home health aide come to his home to clean and dress a burn on his lower leg. The aide uses a special absorptive sterile dressing to cover 20 sq. in. area. She also covers 15 sq. in. area with a self-adhesive sterile gauze pad. Which of th | A6262, A6219 |
| A patient had surgery two weeks ago to repair a dislocated ankle and returns today to have the flexor tendon muscle repaired. Which of the following modifiers should be reported for today's service? | -79 |
| The physician is performing a complicated urethrectomy on a female patient. The patient was tolerating the procedure fairly well until the patient's blood pressure began to drop dangerously low. After having trouble stabilizing the patient, the physician | 53210-53 |
| The patient presents to the ED with RLQ pain and fever. The physician lists appendicitis as a possible diagnosis. Which of the following ICD-10-CM codes should be assigned? | R10.31, R50.9 |
| The patient presents to the ED with severe abdominal pain and constipation. X-rays were ordered to rule out a blockage in the intestine. Which of the following is the correct ICD-10-CM coding? | R10.0, K59.00 |
| The patient presents today for upper gastrointestinal (GI) endoscopy and biopsy of the stomach. Which of the following is the correct CPT code assignment? | 43239 |
| A physician performed a bilateral L4/L5 laminectomy on a patient in an ambulatory surgical center. Which of the following place of service codes should be used on the CMS 1500? | 24 |
| The patient presented with three lacerations. The physician performed the following a simple repair of 2.5 cm. laceration of the arm, a simple repair of a 2.5 laceration of the scalp, and a simple repair of a 2.5 cm laceration of the hand. Which of the | 12002 |
| A patient presented with symptoms of gastric reflux. The physician performed EGD, flexible transoral. The scope was advance to the stomach, but unable to advance to duodenum due to gastric bolus. Physician will return patient for second EGD after course | 43235-53 |
| A patient was diagnosed with cancer of both breasts and was prepped for surgery today. A simple bilateral mastectomy was performed. Which of the following is the correct CPT code assignment? | 19303-50 |
| A 57-year old patient with severe systemic disease is having surgery to remove an integumentary mass from his neck. Which of the following is the correct CPT code assignment for the | 00300-P3 |
| Which of the following is the correct CPT code assignment for mediastinal and region lymphadenectomy with a RT video-assisted thoracic (VATS) lobectomy? | 32663-RT, 32674 |
| Which of the following modifiers is required for a return to the operating room for an unplanned related procedure or service by the same physician during the postoperative period? | -78 |
| A 45-year old patient with diabetic proliferative retinopathy is being seen today for her macular edema. Which of the following ICD-10-CM codes should be assigned? | E11.351 |
| A 43-year old established patient presented to the office for his annual visit. The physician performed a comprehensive history and exam. The physician wrote a refill for chronic condition of Diabetes Mellitus II and Hypertension. Which of the following | 99396, Z00.00, I10, E11.9 |
| The patient's diagnosis is vesicoureteral reflux with nephropathy (without hydroureter) and chronic obstructive pyelonephritis due to E-coli infection. Which of the following ICD-10-CM codes should be assigned? | N13.729, N11.1, B96.2 |
| A 45-year old with ESRD receives a unilateral cadaver kidney transplant. The surgeon performs the bench work in addition to the transplant. Which of the following CPT codes should be assigned? | 50300, 50323 |
| A patient was seen in the office today for a follow up visit for neck and shoulder pain. After 20 minutes of face to face time with more than 50% of the time spent counseling the patient, it was decided the patient would benefit from trigger point | 99213-25, 20553 |
| Patient has returned to the operating room to aspirate a seroma that has developed form a surgical procedure that was performed two days ago. A 16-guage needle is used to aspirate 600 cc's of non-cloudy fluid. Which of the following is the correct CPT | 10160-78 |
| A 70-year old patient was admitted for coronary ASHD. Cardiac catheterization performed showed numerous native vessels to be 70% to 100% blocked. The patient was taken to the operating room. A CABG was performed using five venous grafts and four arterial | 33536, 33522 |
| A 72-year old patient is undergoing a corneal transplant. An anesthesiologist is personally performing monitored anesthesia care. Which of the following modifiers should be reported for the anesthesia? | -AA-OS |
| The patient is hospitalized for diabetes. Upon release the patient consults with a registered dietician. Which of the following Level II HCPCS modifiers should be assigned? | -AE |
| Patient presents to office with cough, chest tightness and sore throat. The physician assessment is URL. Which of the following is the correct ICD-19-CM code assignment? | J06.9 |
| A patient presents for a right sided hip injection. The provider used palpitation for guidance. Which of the following is the appropriate CPT code? | 20610-RT |
| When filing an electronic insurance claim, the insurance and coding specialist processes which o the following forms? | CMS-1500 |
| A patient presents for excision his arm. The lesion was 3 cm with 0.5 cm margins. it was a full thickness removal and the pathology proved it toe be a benign lesion. The closure was simple. Which of the following is the correct CPT code assignment? | 11404 |
| A patient has not had an alcoholic drink for two years but has been diagnosed with alcoholic cirrhosis with ascities. Which of the following ICD-10-CM codes should be assigned? | K70.31, F10.21 |
| The patient presents to the physician's office for an initial encounter of a crushing injury to the middle finger. Which of the following ICD-10-CM codes should be assigned? | S67.193A |
| A patient presents to office with RUQ abdominal pain. The physician sends the patient for HIDA scan to assess for possible cholelithiasis. Which of the following is the correct ICD-10-CM code assignment? | R10.11 |
Created by:
garces
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