Evaluation And Management Modifiers Quiz

1. One of the most common reasons for denial is a missing or incorrect modifier.

True

False

A modifier is a word or phrase that provides additional information about a subject or an action in a sentence. If a modifier is missing or incorrect, it can lead to confusion or change the meaning of a sentence. This can result in denial of a claim or request, especially in written communication where clarity is crucial. Therefore, it is true that one of the most common reasons for denial is a missing or incorrect modifier.

Explanation

A modifier is a word or phrase that provides additional information about a subject or an action in a sentence. If a modifier is missing or incorrect, it can lead to confusion or change the meaning of a sentence. This can result in denial of a claim or request, especially in written communication where clarity is crucial. Therefore, it is true that one of the most common reasons for denial is a missing or incorrect modifier.

2. There are two types of modifiers: informational and payment (reimbursement).

True

False

The statement is true because there are indeed two types of modifiers: informational modifiers and payment modifiers. Informational modifiers provide additional details or clarification about a service or procedure, while payment modifiers indicate changes in reimbursement or pricing for a specific service.

Explanation

The statement is true because there are indeed two types of modifiers: informational modifiers and payment modifiers. Informational modifiers provide additional details or clarification about a service or procedure, while payment modifiers indicate changes in reimbursement or pricing for a specific service.

3. Appropriate usage of modifier(s) should relate to:

Separate patient encounter/service.

Separate anatomic sites.

Separate specimens.

All of the above

The appropriate usage of modifier(s) should relate to separate patient encounters/services, separate anatomic sites, and separate specimens. This means that when reporting medical procedures or services, modifiers should be used to indicate when these elements are distinct and separate from each other. This ensures accurate and specific coding and billing for each separate aspect of the patient's care.

Explanation

The appropriate usage of modifier(s) should relate to separate patient encounters/services, separate anatomic sites, and separate specimens. This means that when reporting medical procedures or services, modifiers should be used to indicate when these elements are distinct and separate from each other. This ensures accurate and specific coding and billing for each separate aspect of the patient's care.

4. E/M also stands for ________ in management.

Earn and make

Escape and margin

Both

None

The correct answer is "None" because the options provided, "Earn and make" and "Escape and margin," do not accurately represent any commonly used acronyms or terms in management that are commonly associated with the abbreviation "E/M." Therefore, the correct answer is that "E/M" does not stand for anything in management.

Explanation

The correct answer is "None" because the options provided, "Earn and make" and "Escape and margin," do not accurately represent any commonly used acronyms or terms in management that are commonly associated with the abbreviation "E/M." Therefore, the correct answer is that "E/M" does not stand for anything in management.

5. E/M codes are used to classify the amount of cognitive service provided, which basically means:

Amount of effort & time.

Amount of responsibility.

Amount of medical skill & knowledge.

All of these

E/M codes are used to classify the amount of cognitive service provided, which includes the amount of effort and time spent, the amount of responsibility taken, and the amount of medical skill and knowledge required. These codes help in determining the level of complexity and intensity of the medical service provided by healthcare professionals.

Explanation

E/M codes are used to classify the amount of cognitive service provided, which includes the amount of effort and time spent, the amount of responsibility taken, and the amount of medical skill and knowledge required. These codes help in determining the level of complexity and intensity of the medical service provided by healthcare professionals.

6. What does Comorbid mean?

Pre-existing

Chronic

Acute

None of these

Comorbid refers to the presence of two or more medical conditions or diseases in an individual at the same time. These conditions are pre-existing, meaning they existed prior to the diagnosis or occurrence of another condition. Therefore, the correct answer is "pre-existing."

Explanation

Comorbid refers to the presence of two or more medical conditions or diseases in an individual at the same time. These conditions are pre-existing, meaning they existed prior to the diagnosis or occurrence of another condition. Therefore, the correct answer is "pre-existing."

7. Which modifier should be used when the assistant (for surgery) is a Nurse Practioner or Physician's Assistant?

80

AS

81

90

The modifier "AS" should be used when the assistant for surgery is a Nurse Practitioner or Physician's Assistant.

Explanation

The modifier "AS" should be used when the assistant for surgery is a Nurse Practitioner or Physician's Assistant.

8. There are three modifiers that we can attach to the E/M services to distinguish it from the global period-what are they? (Check all that apply)

22

24

25

57

The correct answer is 24, 25, and 57. These modifiers are used to distinguish E/M services from the global period. Modifier 24 is used for unrelated E/M services during a postoperative period. Modifier 25 is used for significant, separately identifiable E/M services on the same day as a procedure. Modifier 57 is used for an E/M service that results in a decision for surgery on the same day or the day before a major procedure. These modifiers help to indicate that the E/M service is distinct and separate from the global period.

Explanation

The correct answer is 24, 25, and 57. These modifiers are used to distinguish E/M services from the global period. Modifier 24 is used for unrelated E/M services during a postoperative period. Modifier 25 is used for significant, separately identifiable E/M services on the same day as a procedure. Modifier 57 is used for an E/M service that results in a decision for surgery on the same day or the day before a major procedure. These modifiers help to indicate that the E/M service is distinct and separate from the global period.

Submit

9. 26 & TC are considered informational modifiers.

True

False

The statement is incorrect. 26 & TC are not considered informational modifiers. An informational modifier is a word or phrase that provides additional information about a noun or pronoun. However, "26 & TC" does not provide any additional information about a noun or pronoun. Therefore, the correct answer is False.

Explanation

The statement is incorrect. 26 & TC are not considered informational modifiers. An informational modifier is a word or phrase that provides additional information about a noun or pronoun. However, "26 & TC" does not provide any additional information about a noun or pronoun. Therefore, the correct answer is False.

10. If the procedure/service is bilateral in nature, you need to indicate it with a 50 modifier.

True

False

If the procedure/service is bilateral in nature, it does not need to be indicated with a 50 modifier.

Explanation

If the procedure/service is bilateral in nature, it does not need to be indicated with a 50 modifier.