HCPCS Exam Study Guide

HCPCS Exam Study Guide CPT, HCPCS Level II and HCPCS Level III codes are all HIPAA-approved National Codes Sets. a.) True b.) False - ✔✔b: False. HCPCS Level III codes are not included in the HIPAA-approved National ...

HCPCS Exam Study Guide CPT, HCPCS Level II and HCPCS Level III codes are all HIPAA-approved National Codes Sets. a.) True b.) False - ✔✔b: False. HCPCS Level III codes are not included in the HIPAA-approved National Code Sets. They will be eliminated on Dec. 31, 2003. In most cases, which modifier is needed for an emergency room case when reporting both a CPT surgery code and evaluation and management (E/M) code? a.) 52 b.) 59 c.) 25 - ✔✔c: Modifier -25 is appended to the ED E/M code. Modifier -25 identifies significant, separately identifiable E/M services on the same day of the procedure or other services. In most instances, patients that come to the ED do not present to have a procedure performed. The patient first needs to be evaluated by a physician. HCPCS Level II "A" codes represent: a.)Transportation services, including ambulance b.)Durable medical equipment c.)Temporary medical and surgical supplies - ✔✔a: HCPCS Level II A codes are used to report transportation services, including ambulance. CPT codes and HCPCS Level II codes are updated by CMS annually. a.) True b.) False - ✔✔b: False. HCPCS Level II codes are updated by CMS. CPT codes are not. CPT codes are updated by AMA. A flexible diagnostic colonoscopy is performed. During the procedure, a polyp is removed from one area and a lesion is removed from another. Both the polyp and the lesion are removed by snare technique. Which of the following would be the appropriate code selection? a) 45378-59, 45385, 45385-59 b) 45385, 45385-59 c) 45385 d) 45378-59, 45385 - ✔✔c: Only code 45385 is reported. The diagnostic colonoscopy is not coded separately. Notice the separate procedure designation. The diagnostic colonoscopy is included in the code for any definitive procedure performed. 45385 is not reported twice because the description of the code indicates "with removal of tumor(s), polyp(s), or other lesion(s) by snare technique." Therefore, all tumors, polyps or lesions removed using this technique are reported only once. The same CCI edits are used by CMS for editing both physician and hospital outpatient services. a) True b) Fals - ✔✔b: False. The CCI edits used by CMS to edit physician and hospital outpatient services are not the same. CMS uses the most current version of CCI edits to edit physician services. The CCI edits used by CMS to edit hospital outpatient services are included in the Outpatient Code Editor (OCE) and is one release behind. Also, the CCI edits included in the OCE do not include the entire CCI table. On April 15, 2003, it was appropriate to bill services provided on March 15, 2003, using either 2002 or 2003 HCPCS codes because of the grace period. a) True b) False - ✔✔b: False. On April 15, 2003, it is not appropriate to bill services provided on March 15, 2003, using either 2002 or 2003 HCPCS codes. The three-month grace period is intended to allow providers time to implement the new codes. After April 1st, all claims for services after January 1st must include the new codes. The patient presents to the ED with multiple lacerations. Simple repairs of a 2 cm laceration of the leg and a 3 cm laceration of the back are performed. Another 3 cm laceration of the back was repaired but first required extensive cleaning to remove gravel before the single layer closure was performed. Which of the following would be the appropriate code selection for the laceration repairs? a) 12004 b) 12001, 12002-59, 12002-59 c) 12002, 12032 d) 12001, 12002-59, 12032 - ✔✔c: Codes 12002 and 12032 are assigned. The length of the leg and back wounds are added together because they are both simple repairs from anatomical sites that are grouped together. Code 12002 is assigned. Even though the second 3 cm laceration of the back was a single layer closure, extensive cleansing and removal of gravel were required before the wound could be sutured. Code 12032 is assigned. Please refer to the note in the beginning of the Integumentary/Repair section for instructions. Modifier -52 is used to report the elective cancellation of a procedure that does not require anesthesia because the physician is unavailable. a) True b) False - ✔✔b: False. A code for the intended procedure with modifier -52 is not assigned if a procedure is electively cancelled because the physician is unavailable. Other services provided to the patient may be billed. Where do you find HCPCS level II codes? a) They are at the back of the ICD-9 book. b) The are in Appendix D of the CPT book. c) The are only available from Medicare. d) They are in their own book: HCPCS level II. - ✔✔d) They are in their own book: HCPCS level II. HCPCS level II codes main difference with CPT codes is: a) HCPCS codes can have from 3 to 6 digits. b) HCPCS level II codes begin with a letter. c) HCPCS level II codes DO NOT accept any modifiers. d) HCPCS level II codes end with a letter. - ✔✔b) HCPCS level II codes begin with a letter. HCPCS Level II codes includes what services not represented in CPT? a) Ambulance services, durable medical equipment, Chiropractic services. b) Chemotherapy treatment, durable medical equipment, specific supplies. c) Ambulance services, Neurological testing, specific supplies. d) Ambulance services, durable medical equipment, specific supplies - ✔✔d) Ambulance services, durable medical equipment, specific supplies What HCPCS level II code is used for mesh used during a hernia repair via laparatomy? The mesh is never coded separately but included in the CPT procedure code. a) C1781. b) C9363 c) S2077 - ✔✔b) C9363 Code for the injection of 2,400,000 units of penicillin G benzathine: a) J0560. b) J0570 X 2. c) J0580. d) J0580 X 2. - ✔✔c) J0580. Code for a Knee Orthosis, without knee joint, rigid, custom fabricated: a) L1800. b) L1810. c) L1832. d) L1834. - ✔✔d) L1834. Code for 200 mg of Meperidine HCL: a) J2175. b) J2175 X 2. c) J2180. d) J2180 X 2. - ✔✔b) J2175 X 2. Code the HCPCS level II code for a surgical tray (no longer paid by Medicare): a) A4550. b) E0950 c) 99070. d) A4310. - ✔✔a) A4550. CPCS Codes are: a) Used to bill for supplies such as splints and surgical trays. b) The Health Care Financing Administration (HCFA) Common Procedure Coding System. c) Used to report injections (the drug that is injected). d) All of the above. - ✔✔d) All of the above. J codes (J0000-J8999) are used for which purpose? a) For all administered drugs b) For all drugs that can be injected subcutaneously, intramuscularly or intravenously c) For durable medical equipment (DME) - ✔✔b) For all drugs that can be injected subcutaneously, intramuscularly or intravenously HCPCS level II modifiers F1 through F4 involve which anatomic area? a) Eyelid (upper, lower, right and left) b) Digit of foot c) Digit of hand - ✔✔c, (see modifier descriptions F1-F9 as these denote each digit of both hands) HCPCS code G0101, (cervical or vaginal cancer screening, pelvic and clinical breast examination) cannot be used with an E/M service code on the same day. a) True b) False - ✔✔b, False. As of Jan. 1, 1999, the CCI update allows G0101 to be billed with an E/M visit if the visit is separate from the G0101 service. When both services occur at the same encounter for distinct reasons, modifier 25 should be used with the E/M code on the claim What modifier is used by Medicare for reimbursing monitored anesthesia care? a) 47 anesthesia by a surgeon b) AA anesthesia services performed personally by anesthesiologist c) QS monitored anesthesia care service - ✔✔c) QS monitored anesthesia care service What is the description of code J1940? a) Dynamic adjustable toe extension/flexion device b) AFO, molded to patient model, plastic c) Injection, Lasix, up to 20mg. - ✔✔c, (Lasix is another term for furosemide) Temporary codes assigned by HCFA to procedures, services and supplies before a permanent code is assigned in HCPCS level II are called: a) Q codes b) T codes c) G codes - ✔✔a, Q codes are temporary codes for HCPCS level II inclusion. G codes are temporary codes being considered for inclusion in the CPT level I code book; HCPCS level 2 - ✔✔describes specific products, supplies, and services not in level 1; CMS is responsible for maintaining HCPCS code sets Orthotic - ✔✔A device that supports an impaired body part. Prosthetic - ✔✔A device that replaced a missing body part. Disposable medical supplies - ✔✔Single-use medical supplies (bandages, gauze, etc.) Durable medical equipment (DME) - ✔✔Items used repeatedly (crutches, hospital beds, walkers, etc) True or False? We do not use "D Codes" because the Dental Codes are actually owned by the American Dental Association. - ✔✔True. A Codes - ✔✔Ambulance and transportation codes B Codes - ✔✔Enteral and parenteral therapy C Codes - ✔✔Outpatient Prospective Payment System (OPPS) E codes - ✔✔Durable medical equipment (DME) G codes - ✔✔Physician Quality Reporting Initiative (PQRI) and temporary codes (codes not in CPT yet) H codes - ✔✔Alcohol and drug abuse treatment codes J codes - ✔✔Drugs administered other than oral K codes - ✔✔Wheelchairs and special temporary codes L codes - ✔✔Orthotics and prosthetics M codes - ✔✔Other Medical services P codes - ✔✔Pathology and laboratory services Q codes - ✔✔Miscellaneous services and temporary codes R codes - ✔✔Diagnostic Radiology services S codes - ✔✔Temporary National codes (non-Medicare) T codes - ✔✔Medicaid codes V codes - ✔✔Vision, hearing, and speech pathology services