Medical Coding & Billing — Proficiency Exam

15 questions · pass with 50%

1. Which pair of electronic transactions is used to check a patient's eligibility and benefits before the visit?
The 837 and the 835The 270 inquiry and the 271 responseThe 276 and the 277The CMS-1500 and the UB-04
2. A practice bills 250 dollars for a visit. The contracted allowed amount is 118 dollars and 40 cents. What is the difference?
Additional patient responsibility the practice should billA contractual adjustment the in-network provider writes offAn underpayment that should be appealedA coding error that must be corrected
3. Which measure best reveals revenue the practice was contractually entitled to but never collected?
Net collection rateGross charges postedTotal claim volumeAverage charge per encounter
4. A provider's note does not clearly state whether the patient's diabetes is type 1 or type 2. What should the coder do?
Code type 2, since it is far more commonInfer the type from the medication listSend a neutral provider query asking the clinician to clarifyLeave the diagnosis off the claim entirely
5. A code category requires a 7th character but the base code is only four characters long. What do you do?
Report the four-character code as validAdd zeros until the code reaches seven charactersInsert the placeholder X in the empty positions so the extension is in the 7th slotChoose a different category that does not require an extension
6. An Excludes1 note appears under the code you selected, naming a second condition. What does that tell you?
The two codes may never be reported togetherThe second code must be sequenced firstThe patient may have both, so report bothYou must add a 7th character extension
7. An office note reads: chest pain, rule out myocardial infarction. How is this coded in the outpatient setting?
Code the myocardial infarction as confirmedCode the chest pain onlyCode the myocardial infarction with an unspecified 7th characterHold the claim until the diagnosis is confirmed
8. In ICD-10-CM, what do the first three characters of a code represent?
The payer's coverage tierThe severity of the conditionThe chapter number onlyThe category of the condition
9. Which statement about unspecified codes is correct?
They are always a coding error and should never be submittedThey are correct when documentation truly does not support more specificityThey pay more than specific codesThey are only allowed on inpatient claims
10. Since the 2021 revision, how is the level of an office visit E/M code selected?
By counting history elements and examined body systemsBy medical decision making or total time on the date of the encounterBy the length of the appointment slot bookedBy the number of diagnoses listed on the claim
11. Which CPT code range covers new patient office visits?
99211 to 9921599381 to 9938799202 to 9920599241 to 99245
12. A surgeon performs a procedure with a 90-day global period and sees the patient for routine wound check on day 12. How is that visit reported?
As a level 3 established patient E/MAs a level 1 established patient E/MIt is included in the surgical package and not separately billableWith modifier -59 appended to an E/M code
13. What does the plus symbol next to a CPT code indicate?
The code requires prior authorisationThe code is an add-on code that cannot be reported aloneThe code is a temporary Category III codeThe code always requires modifier -51
14. Which of these counts toward total time for an office visit E/M on the encounter date?
A medical assistant rooming the patient and taking vitalsThe provider reviewing outside records and documenting the noteTime the front desk spends verifying eligibilityA nurse phone call to the patient three days later
15. A provider documents a 60 mg intramuscular dose of a drug whose J-code descriptor reads per 15 mg. How many units do you report?
1 unit15 units4 units60 units

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