MUE is the acronym for:
a. Medicare Unlikely Edits
b. Medically Unnecessary Edits
c. Medicare Unnecessary Edits
d. Medically Unlikely Edits - ANSWERSd. Medically Unlikely Edits
Based on NCCI edits, when a procedure is bundled and has a CCM indicator of 0 - which of the following Modifiers ...
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MUE is the acronym for:
a. Medicare Unlikely Edits
b. Medically Unnecessary Edits
c. Medicare Unnecessary Edits
d. Medically Unlikely Edits - ANSWERSd. Medically Unlikely Edits
Based on NCCI edits, when a procedure is bundled and has a CCM indicator of 0 -
which of the following Modifiers is allowed?
a. 51
b. 59
c. 25
d. Modifiers are not allowed - ANSWERSd. Modifiers are not allowed
Which of the following is considered to be an anatomic modifier?
a. 77
b. LD
c. T5
d. Both B and C - ANSWERSd. Both B and C
Medicare states that reporting bundled codes in addition to the major procedural code is
considered to be unbundling, and if repeated with frequency it is considered to be:
a. Abuse
b. Fraud
c. Misrepresentation
d. False Claims - ANSWERSb. Fraud
A patient is scheduled for a laparoscopic procedure that is converted to an open
procedure after the procedure is initiated. Which of the following would be correct
coding based on CMS NCCI edits?
a. Bill both procedures.
b. Bill only the laparoscopic procedure since that is what was scheduled.
c. Bill only the open procedure (most extensive).
d. Bill both procedures with a modifier appended to the Column 2 code. - ANSWERSc.
Bill only the open procedure (most extensive).
, NCCI is the acronym for:
a. National Correct Coding Institute
b. National Correct Coding Initiative
c. National Coding Clinic Initiative
d. National Coding Coverage Institute - ANSWERSb. National Correct Coding Initiative
Services that are integral to the procedure being performed - such as cleaning and
prepping the skin, opening and closing the surgical site, or any cultures being taken are
considered:
a. Separately billable.
b. Are separately billable if they require additional time.
c. Are included and never separately billable.
d. Individually by payer. - ANSWERSc. Are included and never separately billable.
Modifier 59 is used to unbundle procedures with an indicator of 1. Under what
circumstances would modifier 59 NOT be appropriate?
a. A benign lesion is removed from the upper left thigh that does not need suturing. A
second benign lesion is removed from the lower left thigh but needs an intermediate
suture repair.
b. Destruction of a premalignant lesion on the medial side of the right ankle and a
biopsy of a second lesion on the arm.
c. Breast nodules removed from the right breast at 3 o'clock and at 9 o'clock.
d. Strapping of fracture of left ring and left pinkie finger. - ANSWERSd. Strapping of
fracture of left ring and left pinkie finger.
Documentation requirements for medical necessity are NOT met by
a. Legible medical records for the patient.
b. Selecting an ICD-10-CM code that is supported in the medical record.
c. Selecting an ICD-10-CM code from an approved listing in an LCD or NCD.
d. Documentation that is authenticated by the provider of service. - ANSWERSc.
Selecting an ICD-10-CM code from an approved listing in an LCD or NCD.
Codes that are considered to be bundled are based on Centers for Medicare &
Medicaid (CMS) standards called:
a. LCDs
b. NCDs
c. NCCI
d. MUEs - ANSWERSc. NCCI
Services that are performed for treatment or diagnosis of an injury, illness, or disease in
accordance with generally accepted standards of medical practice defines:
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