Under the Birthday Rule for a dependent child covered by both parents' employer plans, the primary plan is the one belonging to the parent whose:
Medical Benefits Eligibility
Question · Easy
The Birthday Rule Breakdown
Short
A 67-year-old patient is covered by Medicare and a commercial group plan through her actively-employed spouse (employer has 12 employees). Which payer is primary?
Question · Hard
Chapter 1: Introduction & NCICS Exam Overview
1.1 NCCT NCICS Exam Format, Eligibility Routes, & Blueprint Structure
Study guide
Pre-authorization is BEST defined as:
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A new patient presents with a referral from her primary care physician for an in-network specialist. Before the visit, the coding specialist should FIRST:
Which Medicare part covers outpatient physician services and durable medical equipment?
Breaking: 500 patient records exposed
A patient has an HMO plan. The specialist visit is denied because:
Question · Medium
1.2 How to Use This Study Guide & Targeted Exam Strategy
A pre-determination is most accurately described as:
TRICARE Prime requires beneficiaries to:
Coordination of Benefits (COB) is used to:
HIPAA tier list
A patient owes a $30 copay for an office visit. The copay should be collected:
1.3 Medical Terminology & Anatomy Foundations for Coders
Medicaid is BEST described as:
A patient's insurance card lists a deductible of $1,500 (not yet met) and 20% coinsurance after deductible. Allowed charge is $400. The patient owes:
A PPO plan generally:
When a patient has Medicare and Medicaid (a 'dual eligible'), which is typically the secondary payer?
Chapter 2: Medical Coding Principles & ICD-10-CM
2.1 ICD-10-CM Structure, Coding Conventions, & General Rules
An 'allowed amount' on an EOB represents the:
A self-funded employer plan that uses a third-party administrator is regulated PRIMARILY by:
In ICD-10-CM, the placeholder character 'X' is used to:
Medical Coding
When coding a follow-up visit for a fracture during the healing phase, the appropriate ICD-10-CM 7th character is:
2.2 Abstracting Diagnosis Codes from Clinical Documentation
An ICD-10-CM 'Excludes1' note means:
A patient is seen for a routine annual physical with no abnormal findings. The FIRST-listed ICD-10-CM diagnosis code should be from category:
Per ICD-10-CM Official Guidelines, signs and symptoms should be coded:
ICD-10-CM code I10 represents:
2.3 Coding Signs, Symptoms, & Uncertain Diagnoses
A patient is admitted with sepsis due to E. coli urinary tract infection. The first-listed diagnosis is:
ICD-10-CM Z79 codes are used to indicate:
When ICD-10-CM guidelines instruct 'Code first underlying condition,' the coder should:
A pregnant patient with type 2 diabetes mellitus presents for routine OB care. The correct sequencing per ICD-10-CM is:
2.4 Official ICD-10-CM Guidelines for Specific Diagnostic Categories
Which ICD-10-CM code section reports the encounter for screening mammography?
CPT codes are maintained and copyrighted by:
CPT Category I evaluation and management (E/M) codes for office visits are:
Modifier 25 is used to report a:
Chapter 3: CPT & HCPCS Level II Procedural Coding
3.1 CPT Structure, Category Systems, & Evaluation and Management (E/M)
Modifier 59 is appropriate when:
Modifier 50 indicates:
Per CPT guidelines, the global surgical package for a major procedure (90-day global) typically includes:
CPT code 99214 represents an established patient office visit with:
3.2 Abstracting CPT Procedures from Operative Reports
When sequencing CPT codes for multiple procedures on the same date, the coder should list:
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