CBCS Exam Prep QUESTIONS WITH
COMPLETE ANSWERS
Three Categories for E/M Codes Correct Answer: Category I: Procedures that are consistent
with contemporary medical practice and are widely performed.
Category II: Supplementary tracking used for performance measures.
Category III: Temporary codes for emerging technology, services, and procedures.
Anesthesia is found in code ranges: Correct Answer: 00100-01999, 99100-99140
Radiology Correct Answer: 77010-79999
Surgery Correct Answer: 10021-69990
Medicine Correct Answer: 90281-99199, 99500-99607
Path & Lab Correct Answer: 80048-89356
E/M Codes Correct Answer: 99201-99499
History of Present Illness (HPI) Correct Answer: A chronological account of the development of
the complaint from the first sign or symptom that the patient experienced to the present.
Dirty Claim Correct Answer: A claim submitted with errors or one that requires manual
processing to resolve problems or is rejected for payment.
Clean Claim Correct Answer: A completed insurance claim form submitted with the program
time limit that contains all the necessary information without deficiencies so i can be processed
and paid promptly.
Medicaid Categorically Needy: Correct Answer: A distinction for individuals who fall into a
specific category of mandatory Medicaid eligibility established by the federal government. These
categories apply to every state Medicaid program.
Tricare EXTRA Correct Answer: PPO; a preferred provider option, rather than an annual fee, a
yearly deductible is charged. Health care is delivered through a network of civilian health care
providers who accept payments from CHAMPUS and provide services at negotiated, discounted
rates.
Rejected Claim Correct Answer: A rejected claim is an electronically submitted claim that is
isn't process-able due to missing or invalid information required by the payer.
Tricare PRIME Correct Answer: HMO; its a type of plan in which enrollees receive health care
through a Military Treatment Facilities PCM or a supporting network of civilian providers.
, Paper Claims/CMS 1500 Correct Answer: An insurance claim submitted on paper, including
those optically scanned and converted to an electronic form by the insurance carrier.
Electronic Claim*** Correct Answer: An insurance claim submitted to the insurance carrier via
a central processing unit (CPU)
Group Health Plans Correct Answer: An insurance plan that provides healthcare coverage to a
select group of people. Group health insurance plans are one of the benefits offered by many
employers. These are generally uniform in nature, offering the same benefits to all members of
the group.
Invalid Claim Correct Answer: Any medicare claim that contains complete, necessary
information but is illogical or incorrect (e.g., listing an incorrect provider number for a referring
physician). Invalid claims re identified to the provider and may be resubmitted.
The list of Modifiers is found where at in the CPT Book? Correct Answer: In the front of the
book and in Appendix A
Review Linkage Protocol Correct Answer: Appropriateness of Codes, Payers rules about linage,
Documentation to support codes, Compliance with regulation and guidelines.
Evaluation and Management (E/M Codes) Correct Answer: Are listed first in the CPT manual
because they are used by all the different specialties.
Modifier 24 Correct Answer: Attach to E/M service code when service is provided during
postoperative period to indicate the service is not part of postoperative care and not included in
the Surgical Package.
E Codes Correct Answer: Are for durable medical equipment for use in home.
The guidlines are found Correct Answer: in the beginning of each section and used to provide
specific coding rules for that sections.
HIPAA Stands for Correct Answer: Health Insurance Portability and Accountability Act of
1996.
HMO Correct Answer: Health Maintenance Organization is a form of health insurance
combining a range of coverage's in a group basis. A group of doctors and other medical
professionals offer care through the HMO for a flat monthly rate with no deductibles.
Indemnity Insurance Correct Answer: Health indemnity insurance is a fee for service insurance
that is sometimes when a person is in between health plans, and will cover some expenses (but
not all)
Disability Insurance Correct Answer: Is an insurance policy that pays benefits in the event that
the policyholder becomes incapable of working.
COMPLETE ANSWERS
Three Categories for E/M Codes Correct Answer: Category I: Procedures that are consistent
with contemporary medical practice and are widely performed.
Category II: Supplementary tracking used for performance measures.
Category III: Temporary codes for emerging technology, services, and procedures.
Anesthesia is found in code ranges: Correct Answer: 00100-01999, 99100-99140
Radiology Correct Answer: 77010-79999
Surgery Correct Answer: 10021-69990
Medicine Correct Answer: 90281-99199, 99500-99607
Path & Lab Correct Answer: 80048-89356
E/M Codes Correct Answer: 99201-99499
History of Present Illness (HPI) Correct Answer: A chronological account of the development of
the complaint from the first sign or symptom that the patient experienced to the present.
Dirty Claim Correct Answer: A claim submitted with errors or one that requires manual
processing to resolve problems or is rejected for payment.
Clean Claim Correct Answer: A completed insurance claim form submitted with the program
time limit that contains all the necessary information without deficiencies so i can be processed
and paid promptly.
Medicaid Categorically Needy: Correct Answer: A distinction for individuals who fall into a
specific category of mandatory Medicaid eligibility established by the federal government. These
categories apply to every state Medicaid program.
Tricare EXTRA Correct Answer: PPO; a preferred provider option, rather than an annual fee, a
yearly deductible is charged. Health care is delivered through a network of civilian health care
providers who accept payments from CHAMPUS and provide services at negotiated, discounted
rates.
Rejected Claim Correct Answer: A rejected claim is an electronically submitted claim that is
isn't process-able due to missing or invalid information required by the payer.
Tricare PRIME Correct Answer: HMO; its a type of plan in which enrollees receive health care
through a Military Treatment Facilities PCM or a supporting network of civilian providers.
, Paper Claims/CMS 1500 Correct Answer: An insurance claim submitted on paper, including
those optically scanned and converted to an electronic form by the insurance carrier.
Electronic Claim*** Correct Answer: An insurance claim submitted to the insurance carrier via
a central processing unit (CPU)
Group Health Plans Correct Answer: An insurance plan that provides healthcare coverage to a
select group of people. Group health insurance plans are one of the benefits offered by many
employers. These are generally uniform in nature, offering the same benefits to all members of
the group.
Invalid Claim Correct Answer: Any medicare claim that contains complete, necessary
information but is illogical or incorrect (e.g., listing an incorrect provider number for a referring
physician). Invalid claims re identified to the provider and may be resubmitted.
The list of Modifiers is found where at in the CPT Book? Correct Answer: In the front of the
book and in Appendix A
Review Linkage Protocol Correct Answer: Appropriateness of Codes, Payers rules about linage,
Documentation to support codes, Compliance with regulation and guidelines.
Evaluation and Management (E/M Codes) Correct Answer: Are listed first in the CPT manual
because they are used by all the different specialties.
Modifier 24 Correct Answer: Attach to E/M service code when service is provided during
postoperative period to indicate the service is not part of postoperative care and not included in
the Surgical Package.
E Codes Correct Answer: Are for durable medical equipment for use in home.
The guidlines are found Correct Answer: in the beginning of each section and used to provide
specific coding rules for that sections.
HIPAA Stands for Correct Answer: Health Insurance Portability and Accountability Act of
1996.
HMO Correct Answer: Health Maintenance Organization is a form of health insurance
combining a range of coverage's in a group basis. A group of doctors and other medical
professionals offer care through the HMO for a flat monthly rate with no deductibles.
Indemnity Insurance Correct Answer: Health indemnity insurance is a fee for service insurance
that is sometimes when a person is in between health plans, and will cover some expenses (but
not all)
Disability Insurance Correct Answer: Is an insurance policy that pays benefits in the event that
the policyholder becomes incapable of working.
