Certified Revenue Cycle Representative (CRCR) Practice Exam

Which code sets provide additional information to health plans during claim processing?

1. Diagnosis codes, treatment codes, and procedure codes

2. Condition codes, occurrence codes, occurrence span codes, and value codes

3. Revenue codes, modifier codes, and service codes

4. Allergy codes, risk adjustment codes, and payment codes

The correct answer is: Condition codes, occurrence codes, occurrence span codes, and value codes

The choice that includes condition codes, occurrence codes, occurrence span codes, and value codes is correct because these code sets are specifically designed to convey additional information that can influence the processing of claims by health plans. Condition codes, for instance, indicate special circumstances or conditions relating to the bill or coverage that can affect the payment process, such as the use of certain types of facilities or services. Occurrence codes and occurrence span codes provide context about specific events related to the patient's care, such as the dates of surgery or the time period for a particular treatment. Value codes are used to report additional information on claims, such as the number of visits or the cost of certain items that may be relevant for reimbursement. These code sets help ensure that the payer understands the nuances of the situation regarding the patient's care, which is critical for accurate claim processing and payment. This additional information is essential for health plans to assess the validity, appropriateness, and context of the claim submitted.