POS
Inpatient hospital & Outpatient hospital
Inpatient hospital 21
Outpatient hospital 22
How many digits are there in a TOB (Type of Bill) code?
3
Which CPT code range is used for Evaluation & Management (E/M) services?
99202–99499
Which claim form uses Revenue Codes?
UB-04
when the same physician (or qualified healthcare professional) performs both the E/M service and the procedure on the same day. Which modifier is used
POS 23
Emergency Room
In TOB (Type of Bill), the third digit is used to indicate
Third Digit in TOB = Bill Frequency
Which CPT code range is used for Surgery?
10021–69990
How many digits are in a standard Revenue Code
3
Which procedure Shows that the procedures are separate, distinct, and independent?
Modifier 59
In the CMS-1500 claim form, which box is used to report POS (Place of Service)?
24B
In the which claim form & which box/field TOB reported
In UB-04 Under Box-4
Which CPT section includes pathology and laboratory services?
80047–89398
Which Revenue Code is used for professional services billed separately from technical services?
Rev Code -960
Anatomical Modifier (Basic )
Anatomical modifiers are two-character codes added to a CPT or HCPCS code to indicate the specific location or side of the body
LT Left side of the body
RT Right side of the body
50 Bilateral procedure (both sides performed at the same session)
This POS code is used when a service is provided in a physician’s office
11
What are Condition Codes
Which UB-04 box is used for Condition Codes?
Condition Codes are two-character codes used to indicate a special situation or condition that affects a claim.
Who is considered a new patient according to CPT?
What is the look-back period to determine a new patient
99202–99205
3 years
Revenue Code 0720 refers to which hospital service?
Operating Room Services
What is ABN
When ABN is signed which modifier is used
When ABN is not signed which modifier is used
ABN – Advance Beneficiary Notice
GA - When ABN is Signed
GZ - When ABN is not Signed
A nurse practitioner makes a home visit to a patient. Which POS code applies?
12
Condition Codes D0 D1, D4, D6, D9
D0 Change in service dates
D1Change in charges
D4Change in diagnosis/procedure codes
D6Cancel to repay duplicate/overpayment
D9Other changes (requires explanation)
Type of Categories of CPT Codes
Category I - Standard procedures with 5 digits
category II - Quality measurement with 4 digits + 1 letter
Category III - Emerging technology with 4 digits + 1 letter
Which UB-04 box is used to report Revenue Codes?
Why it Used?
Box 42
to indicate: Service location or department
Difference Between Modifier TC & 26
Modifier 26 – Professional Component
Used when the physician provides the professional interpretation or service only.
Modifier TC – Technical Component
Used when only the technical part of the service is performed.