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CPMA Scenario's Exam with complete solutions, Exams of Auditing

Texas A & M University - Corpus ChristiAuditing

CPMA Scenario's Exam with complete solutions

Typology: Exams

2024/2025

Available from 07/05/2025

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CPMA |! Scenario's |! Exam |! with |! complete |!
solutions
Which |! procedure |! is |! exempt |! from |! Modifier |! 59? |! - |! Correct |! answer |! ✔93456
Which |! of |! the |! following |! code |! combination |! are |! NOT |! subject |! to |! a |! multiple |!
procedure |! payment |! reduction? |! - |! Correct |! answer |! ✔32666, |! 32764
In |! febuary |! 2018, |! an |! auditor |! is |! asked |! to |! review |! 10 |! records |! for |! date |! of |! service
|! 12/1/2017 |! to |! make |! sure |! the |! claims |! were |! paid |! correctly. |! The |! claims |!
included |! code |! 55450, |! which |! was |! denied |! on |! all |! the |! claims. |! The |! denial |! was |!
for |! an |! invalid |! code. |! What |! should |! the |! auditor |! advise |! the |! provider? |! - |! Correct
|! answer |! ✔If |! documentation |! supports |! the |! service, |! have |! the |! staff |! to |! write |! off |!
the |! balance
Which |! code |! combination |! is |! appropriate |! to |! report? |! - |! Correct |! answer |!
✔10022, |! 76942
How |! are |! revisions |! to |! coding |! guidelines |! identified |! in |! the |! CPT* |! codebook? |! - |!
Correct |! answer |! ✔Green |! text |! with |! opposing |! arrows
Which |! of |! the |! following |! scenarios |! qualifies |! for |! a |! consultation |! code? |! - |! Correct
|! answer |! ✔A |! patient |! followed |! by |! her |! primary |! care |! physician |! for |! diabetes |! is |!
referred |! to |! an |! endocrinologist |! in |! the |! same |! group |! practice |! to |! review |! the |!
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CPMA |! Scenario's |! Exam |! with |! complete |!

solutions

Which |! procedure |! is |! exempt |! from |! Modifier |! 59? |! - |! Correct |! answer |! ✔ 93456 Which |! of |! the |! following |! code |! combination |! are |! NOT |! subject |! to |! a |! multiple |! procedure |! payment |! reduction? |! - |! Correct |! answer |! ✔32666, |! 32764 In |! febuary |! 2018, |! an |! auditor |! is |! asked |! to |! review |! 10 |! records |! for |! date |! of |! service |! 12/1/2017 |! to |! make |! sure |! the |! claims |! were |! paid |! correctly. |! The |! claims |! included |! code |! 55450, |! which |! was |! denied |! on |! all |! the |! claims. |! The |! denial |! was |! for |! an |! invalid |! code. |! What |! should |! the |! auditor |! advise |! the |! provider? |! - |! Correct |! answer |! ✔If |! documentation |! supports |! the |! service, |! have |! the |! staff |! to |! write |! off |! the |! balance Which |! code |! combination |! is |! appropriate |! to |! report? |! - |! Correct |! answer |! ✔10022, |! 76942 How |! are |! revisions |! to |! coding |! guidelines |! identified |! in |! the |! CPT* |! codebook? |! - |! Correct |! answer |! ✔Green |! text |! with |! opposing |! arrows Which |! of |! the |! following |! scenarios |! qualifies |! for |! a |! consultation |! code? |! - |! Correct |! answer |! ✔A |! patient |! followed |! by |! her |! primary |! care |! physician |! for |! diabetes |! is |! referred |! to |! an |! endocrinologist |! in |! the |! same |! group |! practice |! to |! review |! the |!

patient's |! current |! regimen |! and |! offer |! suggestions |! for |! ongoing |! treatment. |! Her |! diabetes |! has |! been |! difficult |! to |! keep |! under |! control. Determine |! the |! level |! of |! history |! for |! the |! following |! documentation. |! 44 |! year-old |! female |! reports |! that |! she |! stepped |! on |! a |! broken |! piece |! of |! glass |! last |! evening. |! She |! reports |! pain |! in |! the |! bottom |! of |! her |! left |! foot |! has |! persisted |! since |! this |! incident. |! Patient |! reports |! that |! she |! noted |! mild |! bleeding |! from |! this |! area. |! She |! reports |! her |! tetanus |! is |! up |! to |! date. |! She |! denies |! paralysis |! or |! paresthesia. |! - |! Correct |! answer |! ✔Detailed Which |! system |! is |! given |! credit |! for |! the |! exam |! component |! when |! a |! provider |! documents |! "no |! appreciable |! edema |! in |! the |! ankles?" |! - |! Correct |! answer |! ✔Cardiovascular What |! is |! the |! level |! of |! MDM |! for |! the |! documentation |! provided |! below? |! Diabetic |! neuropathy, |! improved |! but |! still |! uncontrolled. |! Still |! having |! insomnia |! is |! contributing |! to |! her |! sugars |! being |! high |! in |! the |! mornings. |! Lyrica |! should |! help |! her |! with |! the |! sleeping; |! we |! will |! monitor |! how |! her |! BS |! responds |! to |! this |! new |! medicine. |! Return |! to |! the |! office |! in |! 4-5 |! weeks. |! - |! Correct |! answer |! ✔Low What |! is |! the |! E/M |! code |! for |! the |! case |! below? 56 |! year-old |! established |! male |! patient |! presents |! with |! the |! chest |! cold, |! denies |! any |! fever |! and |! chills. |! Productive |! cough; |! yellow, |! green |! phlegm. |! Postnasal |! drainage, |! ears |! feel |! pressure, |! headache, |! at |! times. |! Has |! not |! taken |! any |! OTC |! as |! this |! is |! just |! starting, |! has |! had |! approx. |! 3-4 |! days, |! and |! seems |! to |! be |! getting |! worse. |! - |! Correct |! answer |! ✔ 99214

of |! the |! records |! to |! verify |! the |! procedures |! were |! performed, |! what |! recommendation |! would |! you |! make |! to |! resolve |! the |! denials? |! - |! Correct |! answer |! ✔Correct |! the |! modifiers |! and |! resubmit |! the |! claim. |! Medicare |! requires |! modifier |! 50 |! and |! one |! unit |! for |! bilateral |! procedures CT |! images |! were |! taken |! on |! the |! abdomen |! and |! pelvis |! with |! administration |! of |! oral |! contrast. |! Select |! the |! correct |! code? |! - |! Correct |! answer |! ✔ 74176 A |! 60 |! year-old |! female |! has |! pancreatic |! carcinoma. |! She |! is |! taken |! to |! the |! outpatient |! surgical |! center |! and |! undergoes |! placement |! of |! Infuse-A-Port |! for |! chemotherapy. |! Fluoroscopic |! guidance |! was |! used |! to |! help |! the |! physician |! with |! the |! placement |! of |! the |! port. |! What |! is |! the |! correct |! code? |! - |! Correct |! answer |! ✔36561, |! 77001- When |! auditing |! for |! radiology |! services, |! what |! step |! is |! NOT |! performed? |! - |! Correct |! answer |! ✔Verify |! the |! image |! obtained |! meets |! clinical |! standards When |! auditing |! CBC |! tests |! for |! a |! primary |! care |! physician, |! you |! review |! the |! record |! and |! verify |! the |! tests |! were |! performed, |! but |! there |! is |! no |! order. |! When |! you |! question |! the |! provider, |! he |! indicates |! there |! is |! a |! standing |! order |! perform |! a |! CBC |! on |! every |! patient. |! What |! do |! you |! advise |! the |! provider? |! - |! Correct |! answer |! ✔This |! is |! an |! audit |! finding. |! Standing |! orders |! cannot |! be |! used |! in |! this |! manner Which |! of |! the |! following |! scenarios |! will |! result |! in |! an |! auditing |! finding? |! - |! Correct |! answer |! ✔The |! lab |! results |! were |! not |! reviewed |! by |! the |! provider |! after |! the |! tests |! were |! performed

A |! 3 |! year-old |! presents |! to |! the |! office |! with |! his |! mother |! for |! MMR |! vaccine. |! The |! nurse |! confirms |! the |! order; |! adminsters |! the |! subcutaneous |! vaccine; |! and |! documents |! the |! site, |! vaccine, |! lot |! number, |! dosage, |! and |! date |! and |! time. |! Select |! the |! correct |! code. |! - |! Correct |! answer |! ✔90471, |! 90707 Which |! of |! the |! following |! would |! be |! an |! audit |! finding |! for |! psychiatric |! services? |! - |! Correct |! answer |! ✔Reporting |! code |! 90863 |! only Which |! of |! the |! following |! statements |! regarding |! chemotherapy |! administration |! is |! TRUE? |! - |! Correct |! answer |! ✔Hydration |! for |! dehydration |! can |! be |! reported |! seperately Diagnosis: |! Knee |! pain Treatments: |! Therapeutic |! exercise |! each |! 15 |! minutes Hot/ |! Cold |! Packs Goal |! Status: |! Patient |! is |! progressing |! well |! toward |! goals. |! Plan: |! Based |! on |! patient |! progress, |! anticipate |! goals |! to |! be |! achieved |! within |! the |! next |! three |! visits |! with |! discharge |! to |! occur |! at |! that |! time. Electronically |! signed: |! MN |! The |! codes |! submitted |! include |! 97110 |! x |! 97010 After |! review |! of |! the |! documentation |! and |! the |! codes |! submitted, |! what |! audit |! finding |! is |! indicated |! in |! the |! audit |! report? |! - |! Correct |! answer |! ✔The |! patient's |! goal |! status |! is |! not |! properly |! documented Which |! of |! the |! following |! elements |! is |! NOT |! required |! for |! the |! physical |! therapy |! plan |! of |! care? |! - |! Correct |! answer |! ✔Physician |! co-signer |! for |! each |! session