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CPT Review Questions and Answers Already Passed What three components contribute to the calculation of Relative Value Units? Physician work, Practice expense, Malpractice insurance Rationale: Per ... the Centers for Medicare & Medicaid Services (CMS), Relative value units (RVUs) capture the following three components of patient care: Physician work RVU, Practice Expense RVU, and Malpractice RVUs. What codes are voluntarily reported to payers and provide evidence-based performance-measure data? CPT® Category II codes Rationale: Per AMA, CPT® Category II codes are a set of supplemental tracking codes used for performance measurement. CPT® Category III codes reimburse at what level? Reimbursement, if any, is determined by the payer Rationale: Per AMA, there are no relative value units (RVUs) assigned to these codes. Payment for these services or procedures is based on the policies of payers. The Global Surgical Package applies to services performed in what setting? Hospitals Ambulatory Surgical Centers Physician's offices Correct! All of the above Rationale: The services included in the global surgical package may be furnished in any setting, including hospitals, ASCs, and physicians' offices. Visits to a patient in an intensive or critical care unit are also included if made by the surgeon. What surgical status indicator represents the Global Surgical Package for endoscopic procedures (without an incision) where there is no postoperative period after the day of the surgery? 000 Rationale: For endoscopic procedures (except procedures requiring an incision), there is no postoperative period. Surgical status indicator 000 is for endoscopies or minor surgical procedures with no preoperative or postoperative period. Any related services on the day of the procedure are generally included in the fee schedule payment amount and not paid separately; including evaluation and management services on the day of the procedure. What does the acronym HCPCS stand for? Healthcare Common Procedure Coding System Rationale: HCPCS stands for Healthcare Common Procedure Coding System. What chapter in the HCPCS Level II code book lists the code for Wheelchairs? Durable Medical Equipment (E0100-E8002) Rationale: A wheelchair is considered durable medical equipment. In the HCPCS index, look for the term Wheelchair. The majority of the codes listed are E codes. How many days does it take CMS to implement HCPCS Level II Temporary Codes that have been reported as added, changed or deleted? 90 Rationale: Per CMS, temporary codes can be added, changed or deleted on a quarterly basis. Once established, temporary codes are usually implemented within 90 days. This allows the time needed to prepare and issue implementation instructions and to enter the new code into CMS's and the contractors' computer systems and initiate user education. This time also allows instructions, such as bulletins and newsletters, to be sent to suppliers providing them with information and assistance regarding the implementation of temporary codes. What temporary HCPCS Level II codes are required for use by Outpatient Prospective Payment System (OPPS) Hospitals? C codes Rationale: Outpatient PPS (C1713-C9899) Guideline explains C codes are required for Outpatient Prospective Payment System (OPPS). Hospitals to report new technology procedures, medical devices, drugs, biologicals and radiopharmaceuticals that do not have other HCPCS codes assigned. Other facilities may report C codes at their discretion. Which statement is TRUE regarding the instruction for use of the CPT® codebook? Select the name of the procedure or service that accurately identifies the service performed. Rationale: CPT® Instructions for the use of the CPT® code book indicates to "select the name of the procedure or service that accurately identifies the service performed." Instructions for Use of the CPT code book is found in the front of the CPT codebook in the Introduction. What type of CPT® code is "modifier 51 exempt" even though there is no modifier 51 exempt symbol next to it? Add-on codes Rationale: Per CPT® guideline, "all add-on codes found in the CPT® codebook are exempt from the multiple procedure concept." What agency maintains and distributes HCPCS Level II codes? CMS Rationale: CMS maintains and distributes HCPCS Level II codes. 00:0301:36 When procedures are "mandated" by third party payers, what modifier would you use? 32 Rationale: Modifier 32 reports "mandated services". HCPCS Level II includes code ranges that consist of what type of codes? Permanent national codes, miscellaneous codes and temporary national codes Rationale: HCPCS Level II codes consist of permanent national codes, miscellaneous codes, and temporary national codes. What publications does the AMA copyright and maintain? CPT® codebook and CPT® Assistant Rationale: CPT® codebook (all three categories) and CPT® Assistant is published, copyrighted and maintained by AMA. How often are HCPCS Level II permanent national codes updated? Annually Rationale: Permanent national codes are updated once a year in January. What does "non-facility" describe when calculating Medicare Physician Fee Schedule payments? Non-hospital owned physician practices Rationale: "Non-facility" location calculations are for private practices or non-hospital-owned physician practices. Reimbursement is higher for private practices because the practice incurs the full expense of providing the service. What is the correct anesthesia CPT® code for surgery performed on the frontal lobe of the brain? [Show More]

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