Mastering Denials and Coding Review
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Questions and Answers

Which type of denials occur when the payment of one CPT is included in the payment of another CPT?

  • Global denials
  • Coverage Terminated denials
  • Non Covered Services denials
  • Inclusive denials (correct)
  • What action should be taken if a CPT is found to be inclusive according to the CCI Edit?

  • Call insurance for reprocessing
  • Appeal with medical record and screenshots of CCI Edit
  • Send the claim for coding review (correct)
  • Write off the amount
  • Which modifier is used when CPT 71048 is inclusive with 71101?

  • 59-Distinct Procedure Service (correct)
  • 25-Significant, Separately Identifiable Evaluation and Management
  • XE,XP,XS,XU
  • A and C
  • When should modifier 25 be used?

    <p>When separate ENM and Non ENM services is performed in same session by same doctor</p> Signup and view all the answers

    What additional documents can be used for appealing inclusive denials?

    <p>Medical record and screenshots of CCI Edit</p> Signup and view all the answers

    Which type of expenses are included in the Global denial?

    <p>All of the above</p> Signup and view all the answers

    What is the global period for major surgery?

    <p>90 days</p> Signup and view all the answers

    What is the global period for minor surgery?

    <p>10 days</p> Signup and view all the answers

    Which modifier is used when a patient comes for Evaluation and Management Service under a global period that is not related to surgery?

    <p>Modifier 24</p> Signup and view all the answers

    What action should be taken if the Date of Service (DOS) falls under the global period and the Diagnosis (DX) code is different?

    <p>Send the claim to coding to append a modifier</p> Signup and view all the answers

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