Coding Corner Questions: Navigating Medicare’s Online Resources

1. A practice receives an overpayment request from the Centers for Medicare & Medicaid Services (CMS) for not meeting medical necessity related to a biologic infusion. In which instructional guideline can the coding and billing staff find the necessary information on the CMS website to handle this request?
   1. Internet-only manuals
   2. National Correct Coding Initiative
   3. Medically Unlikely Edits
   4. None of the above
2. What does the coding edit modifier indicator “0” mean on the National Correct Coding Initiative Procedure to Procedure table?
   1. Allowed
   2. Not allowed
   3. Not allowed unless with a modifier
   4. Not applicable
3. What edit modifier will allow modifier -59 to bypass the National Correct Coding Initiative edit methodology to allow a claim to be processed when reported with another code?
   1. When the table has it listed as “0”
   2. When the table has it listed as “1”
   3. When the table has it listed as “9”
   4. None of the above
4. When will a Medically Unlikely Edits error occur with a service/procedure?
   1. Removing a gallbladder that has already removed
   2. Giving a male a hysterectomy
   3. Billing for the nursing service and an infusion
   4. All of the above
5. Providers and their office staff will always find medical policies for all Medicare Administrative Carriers in one place on the CMS website
   1. True
   2. False

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