Click here for more sample CPC practice exam questions with Full Rationale Answers

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Click here for more sample CPC practice exam questions and answers with full rationale

Practice Exam

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What makes a good CPC Practice Exam? Questions and Answers with Full Rationale

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Practice Exam

2016 CPC Practice Exam Answer Key 150 Questions With Full Rationale (HCPCS, ICD-9-CM, ICD-10, CPT Codes) Click here for more sample CPC practice exam questions with Full Rationale Answers

Practice Exam

Click here for more sample CPC practice exam questions and answers with full rationale

Billing and updating claims information

I have an urgent question As a biller can you legally update information on a claim on the back end. Due to an import error and an error with EMR format claims were missing information for billing. Can the biller update/enter and or correct this data? My belief is the information should be updated by our software analyst by making the necessary formatting corrections and reimporting the data?

Medical Billing and Coding Forum

Billing patient when referral not obtained

My understanding (correct me if I’m wrong) is that if our office fails to obtain a required referral, we have to write off the visit; we can’t bill the patient.

But what about a situation in which the patient requests to be seen right away without waiting for the referral, and states that if we don’t get it, he will pay out of pocket?

Medical Billing and Coding Forum

Billing for CRNA performing Aline or CVP

Our CRNA’s are employed the hospital and while working under Medical Direction of our attending Anesthesiologist, they may need to perform supplemental procedures such as Aline insertion or CVP’s, which I understand fall under the medical direction guidelines as part of the entire anesthesia plan. But it has come up from an external auditing company that we should be billing for these procedures under the CRNA’s name and not the attending even though the attending was present in the OR at the time of the procedure and has met all other "medical direction" requirements.

My group does not agree with this, so I am trying to find out how everyone else bills for such circumstances. Do you pull those procedures off the attending’s claim and submit a claim for the CRNA’s services? Or do you submit it all under the attending as part of the full scope of anesthesia services?

Medical Billing and Coding Forum

Billing E/M codes along with a therapeutic procedure or a diagnostic procedure

We are struggling with when or if it is ok to bill an E/M office visits with a therapeutic procedure or a diagnostic procedure. How do you know what is considered therapeutic and what is diagnostic? We were told it is up to the discretion of the physician. If a provider only pays for either the E/M or the procedure, can I use modifier 25 to get both paid?

Thank you!

Medical Billing and Coding Forum

OIG Reports Hospital Billing Issues – Adding Modifier 59 for RHC when Heart Biopsy is performed on the same day


In one of the recent reports, the Office of Inspector General (OIG) cites significant issues in which hospitals are making coding errors on Medicare claims. Correct coding of claims is important for hospitals to avoid improper payments, which can lead to recoveries of overpayments. The Centers for Medicare & Medicaid Services (CMS) encourages hospital billing and coding personnel to review the OIG reports and take steps to avoid the problems identified in those reports. It is also very important that claims submitted are supported by documentation in the beneficiary’s medical records. 

In the report, “Hospitals Nationwide Generally Did Not Comply with Medicare Requirements for Billing Outpatient Right Heart Catheterizations with Heart Biopsies,” the OIG analyzed claims to determine if hospitals were correctly reporting modifier -59 for RHCs and heart biopsies. The OIG found that in billing for outpatient RHCs with heart biopsies, hospitals often use modifier -59 inappropriately, which leads to significant overpayments and overpayment recoveries on claims for these services. 

For detail information on OIG audits & findings, visit: https://oig.hhs.gov/oas/reports/region1/11300511.pdf


Coding Ahead

Multi-dose billing

How should I code for 40mg/ml out of a 80mg/ml multi-dose vial of Depo Medrol?
I don’t feel J1040 is appropriate since I will be billing the remaining 40mg/ml on another patient thus over billing.
However, I also don’t feel J1030 is appropriate because the NDC# wouldn’t match up.
Unfortunately, HCPCS does not address multi-dose vials.
Thank you,
Donna

Medical Billing and Coding Forum

Billing extended EEG read to Medicare

I am need of assistance as to how to bill extended EEG’s to Medicare. We are running into an MUE issue when billing EEG’s that are lasting more than 24 hours. I am wondering how others do this? Since Medicare guidelines state you have to bill by read date I am wondering if (depending on the length of the eeg) you would bill example 95951,26 and then 95951,26,59? or 95951,26 and 95951,26,76?

Medical Billing and Coding Forum