CSLB General Building (B) Trade Practice Test

Preguntas de práctica de ejemplo

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1. 1. Coding

   In ICD-10-CM, what does the abbreviation NOS in the Alphabetic Index or Tabular List indicate?

   • a.The code requires an additional character to be complete
   • b.The documentation is unspecified, so an 'unspecified' code is assigned
   • c.The condition should never be coded as a primary diagnosis
   • d.Two separate codes must be combined into one

   Respuesta: b

   Explicación: NOS stands for 'not otherwise specified' and is equivalent to 'unspecified.' It is used when the medical record lacks the detail needed to assign a more specific code. Coders should query the provider when greater specificity is clinically documented but not captured.

2. 2. Coding

   Modifier 26 is appended to a diagnostic service to indicate that only the:

   • a.Professional component (the physician's interpretation) is being billed
   • b.Technical component (equipment and supplies) is being billed
   • c.Global service including both components is being billed
   • d.Service was performed by a resident under supervision

   Respuesta: a

   Explicación: Many diagnostic tests, such as radiology, have a professional component (the provider's interpretation and report) and a technical component (the equipment, supplies, and technician). Modifier 26 reports the professional component alone. Modifier TC reports the technical component, and a code billed without either modifier represents the global (combined) service.

3. 3. Coding

   Which statement about the ICD-10-CM external cause codes (the V, W, X, and Y codes) is correct?

   • a.They may be used as a first-listed or principal diagnosis
   • b.They provide supplemental detail about how an injury occurred and are never sequenced first
   • c.They replace the injury code entirely
   • d.They are only used for laboratory results

   Respuesta: b

   Explicación: External cause codes describe the mechanism, intent, place, and activity related to an injury or condition, adding useful public-health detail. They are always secondary and cannot serve as the principal or first-listed diagnosis. Their use is generally voluntary unless mandated by a state or payer.

4. 4. Coding

   Which resource lists CPT modifiers and their definitions and is essential for accurate procedural coding?

   • a.The CPT codebook, including its appendices
   • b.The CMS-1500 claim form instructions only
   • c.The patient's insurance card
   • d.The remittance advice

   Respuesta: a

   Explicación: The CPT codebook contains the modifiers along with guidelines and appendices that define their proper use. Coders rely on these official descriptions to append modifiers accurately. Using an outdated or incomplete reference can lead to incorrect modifier application and denials.

5. 5. Billing & Claims

   Medicare Part B primarily covers:

   • a.Physician services, outpatient care, preventive services, and durable medical equipment
   • b.Inpatient hospital room and board only
   • c.Long-term custodial nursing home care
   • d.All prescription drugs picked up at a pharmacy

   Respuesta: a

   Explicación: Medicare Part B is medical insurance covering physician services, outpatient hospital care, preventive services, laboratory tests, and durable medical equipment. Beneficiaries typically pay a monthly premium and an annual deductible, then coinsurance. Part B is the source of most professional-service claims billed on the CMS-1500.

6. 6. Billing & Claims

   The electronic equivalent of the paper CMS-1500 professional claim is the:

   • a.837I transaction
   • b.835 remittance transaction
   • c.837P transaction
   • d.270 eligibility inquiry

   Respuesta: c

   Explicación: The 837P is the HIPAA standard electronic transaction for professional claims, corresponding to the paper CMS-1500. The 837I is the institutional version corresponding to the UB-04, and the 835 is the electronic remittance advice. Using the correct transaction format is required for electronic data interchange with payers.

7. 7. Billing & Claims

   A clearinghouse in the billing workflow functions to:

   • a.Receive claims from providers, check and format them, then route them to the appropriate payers
   • b.Set the patient's copayment amounts
   • c.Provide medical treatment
   • d.Assign diagnosis codes to encounters

   Respuesta: a

   Explicación: A clearinghouse is an intermediary that accepts electronic claims from providers, scrubs and standardizes them into the required format, and forwards them to the correct payers. It also returns rejection reports so errors can be fixed quickly. Using a clearinghouse streamlines electronic submission to many payers at once.

8. 8. Reimbursement

   Ambulatory Payment Classifications (APCs) are the basis for Medicare payment in the:

   • a.Hospital outpatient prospective payment system
   • b.Inpatient DRG system
   • c.Physician fee schedule
   • d.Retail pharmacy benefit

   Respuesta: a

   Explicación: APCs group outpatient hospital services that are clinically similar and require comparable resources, assigning a payment rate to each group under the outpatient prospective payment system. Multiple APCs can apply to a single outpatient visit. This is the outpatient facility counterpart to the inpatient DRG system.

9. 9. Compliance & Regulatory

   The HIPAA Privacy Rule primarily protects:

   • a.Only electronic billing software
   • b.The privacy of individually identifiable health information (protected health information)
   • c.A provider's business financial records only
   • d.The design of insurance ID cards

   Respuesta: b

   Explicación: The HIPAA Privacy Rule sets national standards protecting individuals' protected health information (PHI) held or transmitted by covered entities and their business associates. It limits how PHI may be used and disclosed and grants patients rights over their information. Billing staff must safeguard PHI and disclose only the minimum necessary.

   Fuente: HIPAA

10. 10. Compliance & Regulatory

    The Office of Inspector General (OIG) of the Department of Health and Human Services is primarily responsible for:

    • a.Detecting and preventing fraud, waste, and abuse in federal health care programs
    • b.Setting physician office hours
    • c.Assigning CPT codes
    • d.Selling insurance policies

    Respuesta: a

    Explicación: The OIG protects the integrity of HHS programs, including Medicare and Medicaid, by investigating fraud and abuse, conducting audits, and issuing compliance guidance. It maintains a list of individuals and entities excluded from federal health programs. Providers check this exclusion list to avoid employing or contracting with excluded parties.

    Fuente: CMS