Deck 8: Outpatient Billing

Question 1

The ambulatory payment classification (APC) payment methodology was modeled based on a "package" concept similar to diagnosis-related groups (DRGs).

Answer 1

True

Question 2

All outpatient service reimbursements are based on the APC methodology.

Answer 2

False

Question 3

Under the APC methodology, a surgical procedure includes incidental drugs, observation care, operating room charges, and anesthesia.

Answer 3

True

Question 4

A service indicated as Payment Status Indicator "T" will be surgical services.

Question 5

Emergency room visits would be assigned Payment Status Indicator "X."

Question 6

Electrocardiograms (EKGs) require that an HCPCS/CPT code be assigned on the UB-04 (CMS-1450) claim form.

Question 7

Procedures performed in the operating room require the assignment of HCPCS/CPT codes.

Question 8

APC is a reimbursement tool developed by CMS and other carriers for editing claims.

Question 9

All outpatient services are sent to the Coding Department/Health information management (HIM) Department for procedure and diagnosis coding.

Question 10

The admission and discharge hours are not required on outpatient hospital claims.

Question 11

A patient who is a full-time student would be indicated by Condition Code 31 or 33 as applicable.

Question 12

Responsible party information is required on all outpatient facility claims.

Question 13

Payment Status Indicators assigned to all outpatient facility services indicate:

A) how services will be paid.
B) whether services will be paid.
C) the method by which services will be paid.
D) all of the above.

Question 14

Payment Status Indicator "S" would be assigned for what types of service?

A) Immunizations and Vaccines
B) Significant Procedures
C) Blood and Blood Products
D) Visit Services

Question 15

Payment Status Indicator "X" includes all but:

A) immunizations.
B) surgeries.
C) radiology services.
D) electrocardiograms.

Question 16

Cardiac Catheterizations would be assigned what revenue code?

A) Revenue Code 045X
B) Revenue Code 0481
C) Revenue Code 0623
D) Revenue Code 070X

Question 17

A claim returned to the provider due to invalid diagnoses codes would be assigned what disposition code as an OCE edit?

A) Return to Provider (RTP)
B) Line Item Denial
C) Claim Denial
D) Service Line Denial

Question 18

Based on the information provided in Table 8-8, an ER Visit Level 3 would be assigned what APC assignment?

A) APC 0605
B) APC 0601
C) APC 0606
D) APC 0614

Question 19

An electrocardiogram would be assigned what APC classification?

A) APC 0284
B) APC 0438
C) APC 0099
D) APC 0190

Question 20

The designation for an outpatient hospital facility claim, admit through discharge, would be which type of bill?

A) Type of Bill 0131
B) Type of Bill 0111
C) Type of Bill 0130
D) Type of Bill 0121

Question 21

The condition code entered for an employment-related encounter would be:

A) Condition Code 17.
B) Condition Code 02.
C) Condition Code 42.
D) Condition Code 44.

Question 22

What occurrence code would be appropriate for a claim that is auto accident-related?

A) Occurrence Code 17
B) Occurrence Code 44
C) Occurrence Code 01
D) Occurrence Code 16

Question 23

A value code of A1 would indicate:

A) patient weight.
B) patient height.
C) co-payment payer A.
D) deductible payer A.

Question 24

A Revenue Code of 045X would indicate:

A) respiratory services.
B) emergency room services.
C) physical therapy services.
D) speech therapy services.

Question 25

What would be the appropriate CPT and APC code assignment for a ER Level 2 visit?

Question 26

What would be the appropriate CPT code and APC assignment for a chest x-ray, posterioranterior (PA) and lateral?

Question 27

What would be the appropriate CPT code and APC assignment for IV Hydration from 10:00 a.m. to 12:10 p.m.?

Question 28

If payment is to be sent to another address other than that listed in FL 1, where should that information be entered?

Question 29

What occurrence code would be appropriate when the encounter is due to a no-fault automobile accident?

Question 30

What would be the appropriate revenue code and descriptor for the following services?