CPB Medical Billing case studies
CPB Medical Billing · Put your knowledge to work in context.
The Certified Professional Biller (CPB) is a credential offered by AAPC that validates expertise in the medical billing process. According to AAPC, earning the CPB demonstrates proficiency in claim submission, payment posting, insurance guidelines, and revenue cycle workflows that ensure healthcare providers are reimbursed accurately and on time. The CPB Medical Billing case studies are 5 cases and about 3,842 words.
1Same-Day E/M and Lesion Destruction: Modifier 25, Modifier 59, and Unit Errors
Valley Internal Medicine bills a commercial PPO for an established-patient visit on March 4. The note documents a 67-year-old with three weeks of fatigue, a full review of systems, a detailed exam, and a decision to order CBC and TSH - the work supports 99214.
804 words, about 4 min2Medicare Advantage, a Working-Aged Group Health Plan, and an Unauthorized Chondroplasty
Chen, 72, is enrolled in a Medicare Advantage HMO and is also covered by her current employer's group health plan (58 employees), where she still works 30 hours a week. She is scheduled for knee arthroscopy.
783 words, about 4 min3Medical-Necessity Denial on a Fusion and a Charify-Care Account Sent to Collections
Northside Orthopedics submits a Medicare claim for a two-level lumbar fusion (22612, 22614, 22842) totaling 4,860 in allowed charges. The MAC denies with CARC 50, citing a local coverage determination that requires at least six weeks of documented conservative therapy before surgery.
742 words, about 4 min4Spouse-Owned PT Clinic, a Subpoena Without Authorization, and a Stolen Laptop
Patel is a 50% owner of a six-physician orthopedic group. His wife owns 60% of a standalone physical therapy clinic three miles away; the clinic is a separate entity, not owned by the group, and not located in the group's office.
781 words, about 4 min5Screening Colonoscopy With Polypectomy: Preventive Coding and Cost Sharing
A 58-year-old man with an ACA-compliant commercial plan undergoes a screening colonoscopy (Z12.11) at an ambulatory surgery center. During the procedure the gastroenterologist removes a 6 mm sigmoid polyp by snare (CPT 45385) and documents the findings.
732 words, about 4 min