CPT- Intro to HCPCS Questions and Answers with Certified Solutions

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CPT- Intro to HCPCS Questions and Answers with Certified Solutions What is HCPCS ✔✔Established in 1978 Healthcare Common Procedure Coding System HCPCS Level 1 CPT codes used for ✔✔Identify... medical services and procedures furnished by physicians, other health care,professions and facility outpatient areas. How can you tell a Level I CPT code ✔✔Its a 5 digit numeric code, ie 47652- Laparoscopic Cholecystectomy Standard coding system used for Medicare (and other health insurance program) claims Consists of two principal subsystems; Level I- CPT Level II- National Codes ✔✔HCPCS What are the types of Levels in HCPCS ✔✔Level I, Level II and Level III What is Level II HCPCS used for ✔✔Codes and descriptions for services and supplies (medical supplies, durable medical equipment, injections/drugs, orthotics and prosthetics, opthamologic services, wheelchairs, drugs, walkers & scooters, etc. Who maintains Level I HCPCS codes ✔✔AMA, annually Who maintains Level II HCPCS codes ✔✔CMS, annually How can you tell its a Level II HCPCS code ✔✔Always begins with a letter followed by 4 numbers its a 5 digit alphanumeric code ( letter A-V, except S & I, + 4 digits ie. A0000 - V9999 What does the letter denote in Level II HCPCS codes ✔✔types of services or supplies What does a J code, Level II HCPCS code mean ✔✔drug codes What does a L code, Level II HCPCS code mean ✔✔orthotics and prosthetic procedures and devices What does a G code, Level II HCPCS code mean ✔✔temporary procedures and professional services What do numerals denote in Level II HCPCS ✔✔Specific codes or supply What are Level III HCPCS codes used for ✔✔Codes and descriptions for physician and non physician services/procedures not covered by Level I or Level II codes Who maintains Level III HCPCS codes ✔✔Local payer, State of California for Medi-Cal How can you tell its a Level III HCPCS code ✔✔its a 5 digit alphanumeric code, letter W-Z + 4 digits ie. W0000- Z0000 What are the types of reimbursement for free standing ambulatory surgery centers and hospital based outpatient services ✔✔ASC use HCPCS for ASC procedures- 8 ASC categories, or Classification What is the Correct Coding Initiative ✔✔Also known as NCCI Implemented in 1996 for Medicare Part B claims Promotes national correct coding methodologies and controls improper coding leading to inappropriate payment Claims are reviewed against over 650,000 prepayment edits Define Healthcare Fraud ✔✔Any person who knowingly and willfully executes, or attempts to execute a "scheme or device" to defraud any health care benefit program, or to obtain any of the money or property owned by or under the custody or control of any benefit program in connection with the delivery of or payment for health care benefits or services Define Upcoding ✔✔selecting a diagnostic code based on reimbursement; that the person knows or "should know" will result in a greater patent that the code "the person knows or should know" is applicable to the item or service actually provided. ie. Lab lipid panel unbundled get more $$ Define Fragmenting/Unbundling ✔✔Pulling apart services/procedures ie. lipid panel , each test billed- unlawful person knows or should know not allowed [Show More]

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