A 16-year-old patient is seen for an evaluation of left ankle pain. He has been a patient of Dr. Smith’s since infancy and Dr. Smith always performs the patient’s annual sports physical exam. During this visit the physician performs a medically appropriate history and examination, and medical decision making is of low complexity. Using the office equipment, a 2-view X-ray is taken of the left ankle which shows normal skeletal structures, no fractures identified. What are the CPT® codes for this encounter? A.99202; 73590-LT B.99213; 73590-LT C.99213; 73600-LT D.99212; 73610-LT
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When submitting a Medigap policy, which option is an example…
When submitting a Medigap policy, which option is an example of how the patient’s ID number should appear in item 9a of the CMS-1500 claim form? A.123456789 B.123456789A C.MGAP 123456789 D.AETNA 123456789 MEDIGAP
Which of the following scenarios would support billing incid…
Which of the following scenarios would support billing incident-to services? A.New patient seen by a mid-level provider who is an employee of the physician. B.Established patient seen by a mid-level provider for follow-up for blood pressure check, physician is in the office suite. C.Established patient seen by a mid-level provider for an established problem, the physician is performing hospital rounds. D.New patient to the practice, physician in exam room next door, mid-level provider is an employee of the physician.
To report the location, condition, or circumstances of an in…
To report the location, condition, or circumstances of an injury, poisoning, or adverse effect, which type of ICD-10-CM code is reported? A.Z-code B.External cause code C.Combination code D.Manifestation code
An indicator that a practice has a successful billing proces…
An indicator that a practice has a successful billing process would be which of the following? A.A low amount of contractual adjustments B.A high amount of contractual adjustments C.A high number of A/R days D.A low number of A/R days
Which do private companies contract with CMS to administer?…
Which do private companies contract with CMS to administer? A. Medicare Part A & B B. Medicare Part B C. Medicare Part C D. Medicare Part A, B, & C
Which of the following statements is true regarding the non-…
Which of the following statements is true regarding the non-PAR Medicare allowed fee schedule? A.The non-PAR provider can bill the patient the difference between the charge and the Medicare allowable. B.The non-PAR limiting charge is 115% of the non-PAR Medicare Physician Fee Schedule. C.The non-PAR Physician Fee Schedule is 115% of the PAR Medicare Physician Fee Schedule. D.The non-PAR limiting charge is 95% of the PAR Medicare Physician Fee Schedule.
To compare units of service with CPT® and HCPCS level II cod…
To compare units of service with CPT® and HCPCS level II codes, CMS added which of the following to the NCCI program? A.Medically utilized edits B.Medically undetermined edits C.Medically unlikely edits D.Medically unusual edits
Case 3 Surgical Specialists-Outpatient Surgery Preauthorizat…
Case 3 Surgical Specialists-Outpatient Surgery Preauthorization Form Date: 08/01/20XX Surgeon: Brian Surgery, MD Assistant Surgeon: John Smith, MD Surgeon NPI: 8908900989 Member Name: Doe Jane A Last First Middle Date of Birth: 06/07/1971 Insurance Carrier: Medical Insurance Specialists Policy Number: 589908765 Group Number: 97809 Date of Surgery: 8/15/20XX Facility Name: General Outpatient Hospital Surgical Center Facility NPI: 4567891923 Facility Address: 1234 Main Street, Here, TX Diagnosis: Old disruption of posterior cruciate ligament Diagnosis code: M23.50 Procedure: Arthroscopic posterior cruciate ligament repair Procedure code: 29889 Fee for Procedure: $2500.00 Contracted Fee: $2000.00 Type of Care (select one): ____ Inpatient ____ 23 Hour Observation X Outpatient Type of Anesthesia (select one): X General ____ Local Preauthorization Number: 2348995786 Insurance Paid Percentage: 70% of the allowable rate after $1500 deductible is met. Patient Responsibility: Patient has $700 deductible remaining that must be met. After deductible is met, patient pays 30% of the allowable rate. 49.Based on the information obtained during the preauthorization, how much is patient responsibility if the claim is paid? A.$910.00 B.$1500.00 C.$1650.00 D.$1090.00
Medicare Part A is available to individuals under the age of…
Medicare Part A is available to individuals under the age of 65 who have which of the following? A.Diabetes mellitus type I or II B.Chronic kidney disease (CKD) C.End-stage renal disease (ESRD) and meet certain requirements D.Any chronic health condition