AAPC CPB - Chapter 9 Practical Application
Exam Practice Questions and Answers
(100% Pass)
Case 1 - Clearinghouse Rejections Report
Status: 11/19/20XX Contents: C4450 - Principal Diagnosis Code must be
valid; REJECTED BY SYSTEM EDI; Rejected
Patient Name: Adams, David
Patient Number: 384594
...
Certified Professional Biller By: American Academy of Professional Coders(AAPC)
I. Review the medical records to verify the ICD-10-CM code is correct.
II. Review the ICD-10-CM codebook to verify it is a correct diagnosis code.
III. Adjust the charge as this is not a covered diagnosis by the insurance
carrier.
IV. Override the clearinghouse edit as this is a valid code.
a. II and III
b. I and II
c. I, II, and IV
d. II and IV - Answer✔️✔️-b. I and II
Response Feedback:
According to the Clearinghouse report, the diagnosis code is invalid. The
biller should look in the ICD-10-CM codebook to determine the validity of
the code. In the ICD-10-CM codebook, the code requires another character.
Certified Professional Biller By: American Academy of Professional Coders(AAPC)
The medical record should be reviewed to determine the additional
character and a correct claim refiled.
Case 2 - Clearinghouse Rejections Report
Status: 10/18/20XX Contents: C4655 - Not eligible (Inactive) for service;
REJECTED BY SYSTEM EDI; Rejected
Patient Name: Smith, John
Patient Number: 584263
Payer: AAPC Health Plan
Submission Date: 10/18/XX
Date of Service: 10/17/XX
Charge: $450.00
Provider: Post, Alexis
According to this clearinghouse rejections report, what actions should be
taken on the claim for John Smith, Date of Service 10/18/20XX?
I. Verify the insurance card information in the patient's file.
3
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