AAPC CPB - Chapter 11 - Practical
Application
Use 2025_MBT_CPB_PA_Student_Ch11_Case 1.pdf
to answer questions 1 & 2.
After review of the information provided, are there any errors on the claim form? If so,
which elements are incorrect?
I. The provider must accept assignment
II. Provider name conflict
III. Medicare ID number is missing information
IV. Medicaid ID number is missing information
V. Medicare ID number in the wrong field
VI. Medicaid ID number in the wrong field
VII. Ordering provider name and NPI
VIII. Place of service code
IX. Diagnosis code(s)
X. Diagnosis pointer(s) - ANS - I, VI, IX, X
When providers provide physician services to individuals dully entitled to Medicare and
Medicaid, they are required to accept assignment. The patient's Medicaid number
should be listed in item 10d. For Medicare, only one diagnosis pointer is entered per line
item. Apnea NOS is not mentioned in the medical record and documentation supports
ICD-10-CM code I21.9 Acute Myocardial Infarction, unspecified, rather than I21.3.
Use 2025_MBT_CPB_PA_Student_Ch11_Case 1.pdf
to answer the following question.
What should be done to correct this claim?
I. Correct assignment on the claim.
II. Correct primary insurance information on the claim.
III. Correct secondary insurance information on the claim.
IV. Correct the provider information on the claim.
V. Correct the diagnosis on the claim.
VI. Correct the diagnosis pointer(s) on the claim - ANS - I, III, V, VI
, When providers provide physician services to individuals dully entitled to Medicare and
Medicaid, they are required to accept assignment. Item 27 should be marked yes. The
patient's Medicaid number should be listed in item 10d. For Medicare, only one
diagnosis pointer should be entered per line item. On this claim, three are entered.
Apnea NOS (R06.81) is not mentioned in the medical record documentation that
supports ICD-10-CM code I21.9 Acute Myocardial Infarction, unspecified, rather than
I21.3.
Use 2025_MBT_CPB_PA_Student_Ch11_Case 2.pdf
to answer questions 3 and 4.
After review of the information provided, are there any errors on the claim form? If so,
which elements are incorrect?
I. Patient name
II. Primary insurance ID number
III. Authorization number
IV. Place of service
V. Site of service
VI. Provider NPI number
VII. CPT® code
VIII. Modifier
IX. Diagnosis conflict
X. Units of service - ANS - I and VII
The patient's name on the claim form must be identical to the name on the patient's
Medicare card. The patient is an established patient but a new patient visit is reported.
Use 2025_MBT_CPB_PA_Student_Ch11_Case 2.pdf
to answer the following question.
What should be done to correct this claim?
I. Correct the patient's name on the claim.
II. Review the medical record to verify the diagnosis code.
III. Add the correct modifier.
IV. Add the authorization number.
V. Correct the CPT® code. - ANS - I and V
The name on the claim form should be changed to BROWN DONNY JOE. The CPT
code for a level IV established patient office visit is 99214.
Application
Use 2025_MBT_CPB_PA_Student_Ch11_Case 1.pdf
to answer questions 1 & 2.
After review of the information provided, are there any errors on the claim form? If so,
which elements are incorrect?
I. The provider must accept assignment
II. Provider name conflict
III. Medicare ID number is missing information
IV. Medicaid ID number is missing information
V. Medicare ID number in the wrong field
VI. Medicaid ID number in the wrong field
VII. Ordering provider name and NPI
VIII. Place of service code
IX. Diagnosis code(s)
X. Diagnosis pointer(s) - ANS - I, VI, IX, X
When providers provide physician services to individuals dully entitled to Medicare and
Medicaid, they are required to accept assignment. The patient's Medicaid number
should be listed in item 10d. For Medicare, only one diagnosis pointer is entered per line
item. Apnea NOS is not mentioned in the medical record and documentation supports
ICD-10-CM code I21.9 Acute Myocardial Infarction, unspecified, rather than I21.3.
Use 2025_MBT_CPB_PA_Student_Ch11_Case 1.pdf
to answer the following question.
What should be done to correct this claim?
I. Correct assignment on the claim.
II. Correct primary insurance information on the claim.
III. Correct secondary insurance information on the claim.
IV. Correct the provider information on the claim.
V. Correct the diagnosis on the claim.
VI. Correct the diagnosis pointer(s) on the claim - ANS - I, III, V, VI
, When providers provide physician services to individuals dully entitled to Medicare and
Medicaid, they are required to accept assignment. Item 27 should be marked yes. The
patient's Medicaid number should be listed in item 10d. For Medicare, only one
diagnosis pointer should be entered per line item. On this claim, three are entered.
Apnea NOS (R06.81) is not mentioned in the medical record documentation that
supports ICD-10-CM code I21.9 Acute Myocardial Infarction, unspecified, rather than
I21.3.
Use 2025_MBT_CPB_PA_Student_Ch11_Case 2.pdf
to answer questions 3 and 4.
After review of the information provided, are there any errors on the claim form? If so,
which elements are incorrect?
I. Patient name
II. Primary insurance ID number
III. Authorization number
IV. Place of service
V. Site of service
VI. Provider NPI number
VII. CPT® code
VIII. Modifier
IX. Diagnosis conflict
X. Units of service - ANS - I and VII
The patient's name on the claim form must be identical to the name on the patient's
Medicare card. The patient is an established patient but a new patient visit is reported.
Use 2025_MBT_CPB_PA_Student_Ch11_Case 2.pdf
to answer the following question.
What should be done to correct this claim?
I. Correct the patient's name on the claim.
II. Review the medical record to verify the diagnosis code.
III. Add the correct modifier.
IV. Add the authorization number.
V. Correct the CPT® code. - ANS - I and V
The name on the claim form should be changed to BROWN DONNY JOE. The CPT
code for a level IV established patient office visit is 99214.
