|
The Coders responsibility is to ensure that the data are as accurate as poosible |
True |
|
The Federal Register is the official publication for all Presidential Docum. |
True |
|
Natioonal unit values have been assigned for each service by Medicare |
True |
|
Fraud is an intentional deception or misrepresentive on that an individual knows to be false or does not believe to be true |
True |
|
Kickbacks from patients are allowed under certain circumstance according to Medicare guidelines |
False |
|
When using an unlisted code a _____must accompany the claim |
C. Special Report |
|
The surgical package includes: |
B. Typical follow-up Care |
|
Local anesthesia is defined in the CPT guidelines as |
D. All of the above |
|
The usual global surgery period for a major procedure is |
D. 90 Days |
|
The global surgery period includes |
A. All routine preoperative and postoperative care |
|
Incision and drainage codes are divided into subcategories according to the |
B. Condition for which the procedure is performed |
|
When an excision is being performed the ‘margins" refer the ______required to adequately excise the lesion based on the physicians judgment |
B. Narrowest margin |
|
What two items are needed to correctly code for local treatment of burns? |
C. Percentage of body surface and depth of burn |
|
This information is placed after some codes in the CPT manual and contains helpful information |
A. Parenthetical information |
|
What code is used to report routine postoperative care |
C. 99024 |
|
What are divisions of the surgery sections of CPT based on |
C. Body System |
|
Excision of pilonidal cyst that was a complicated procedure |
C. 11772 |
|
When the words "separate procedure" appear after the descriptor of a code, yoou know which of the following about that code |
C. The procedure was a minor procedure that would only be coded if it was the only service provided |
|
Excision including closure of benign lessons of the skin including this type of anesthesia |
A. Local |
|
The CPT code that is used to report material and supplies by the physician for which no other more specific CPT code exists is: |
A. 99070 |
|
A triangle before a code indicates that the code is or has been |
D. Revised |
|
The incentive to Medicare participating is: |
D. All of the above |
|
Part B services are billed using |
B. ICD-10 CM, CPT, HCPCS |
|
Who is the largest third-party payer in the nation |
D. The Government |
|
The physician fee schedule is updated each April 15 and is composed of |
D. All of the above |
|
Medicare sets the payment level for assistants at surgery at a percentage of the fee schedule for the _______surgical services |
A. Global |
|
What are the items that the Medicare beneficiaries are responsible to pay before Medicare will begin to pay for services |
D. Deductibles, premiums, and coinsurance |
|
Medicare funds are collected by |
B. Social Security Administration |
|
Which of the following is NOT a stated goal of the Physician Payment Reform? |
C. Limit provider liabilities |
|
The Medicare prescription drug improvement, and Modernization Act of 2003 established these new benefits available under the Medicare program |
D. Part D |
|
This Program is also known as Medicare Advantage |
C. Part C |
|
The correct code for repairing the following lacerations: 4.2 simple repair of the trunk, 1.3 simple repair of the arm, and 2.8 intermediate repair of the scalp |
D. 12032, 12002-51 |
|
When reporting a staged procedure what modifier is added to the CPT code? |
C. -58 |
|
Destruction of 7 actinic keratoses: |
D. -17000, 17003 x 6 units |
|
Which modifier indicates a significant, separately identifiable E/M service |
A. -25 |
|
If you want to bill the removal of skin tags using codes 11200 and 11201. you would need to know with absolute certainty |
C. The number of tags removed |
|
Mr. Anderson has dropped a hammer on his big toe resulting in the collection of blood beneath the nail |
A. 11740 |
|
Jessica Reynolds is a 33 y/o woman with two children. She has been using implantable contraceptives for five years |
B. 11977 |
|
Suffix meaning a technique involving molding or surgically forming |
C-plasty |
|
Oter layer of skin |
B. epidermis |
|
A graft taken from the patient’s own body is called: |
C. Autograft |
|
National Correct Coding Initiative (NCCI) |
Automated edits that identify pairs of services that normally should not be billed by the same physician for the same patient on the same day are part of the |
|
Dr. Wells began surgery on an 86-year-old female with severe hypertension. The patient was satisfactorily anesthetized and the site opened to view. Shortly thereafter, the patient’s blood pressure dropped significantly, and the physician was unable to stabilize the patient. The procedure was discontinued. |
Modifier -53 |
|
The patient is a 10-month-old boy who fell while trying to walk. He cut the bottom of his lip open. Sutures are necessary, but due to the patient’s age and excessive movement, general anesthesia is needed. |
Modifier -23 |
|
A patient has a hernia repair and 2 days later must be returned to the operating room for a dehiscence of the incision. When coding the secondary hernia repair, which modifier would you add onto the surgical codes? |
Modifier -78 |
|
A surgeon performed a repair of an enterocele using an abdominal approach and reported the service with 57270. Then patient was morbidly obese with a BMI of 42, and due to this circumstance, the procedure took a significant amount of additional time to perform. |
Modifier -22 |
|
During a radical right descended orchiectomy for an extensive malignant tumor (54435), the patient began to hemorrhage. After considerable time and effort, the hemorrhage was controlled. |
Modifier -22 |
|
Modifier -TC means: |
Technical Component |
|
Adding modifier ______________, Unusual Services modifier, indicates "additional effort or time": |
Modifier -22; May still not be compensated at a higher rate, even with a report, if the carrier doesn’t agree. |
|
The modifier -23, ____________ would not be appropriate for the use of a accupuncture |
Unusual anesthesia |
|
Modifier -24 should always be used with: |
Evaluation and Management codes. |
|
If general anesthesia is applied, modifier -23 should be used when your CPT manual notes under the CPT code: |
Procedure "usually performed without anesthesia or under local anesthesia." |
|
Some CPT codes are "Technical Service only". This means: |
Only the "facility", most often a hospital, would bill for services (use of the equipment.) |
|
The use of a magnifying surgical loupe qualifies the use of modifier -20, microsurgery: |
Modifier -20 has been deleted from CPT and can no longer be used. |
|
Which of the following modifiers are considered informational only (will not impact reimbursement)? |
Modifiers -24, -32, and -57 |
|
What is the word that means assigning multiple codes when one code would do? |
Unbundling |
|
What is another term for the time after the surgery that the physician provides services to the patient? |
Postoperative Services |
|
Anesthesia provided by the ENT physician during a tympanoplasty for repair of a tympanic membrane perforation. |
Modifier -47 |
|
A patient is seen at the direction of Workers’ Compensation for a complete physical examination for insurance certification. |
Modifier -32 |
|
The patient returns to the operating room for removal of deep pins during the postoperative period, due to complication (dislodged) after an open repair of a humerus fracture. |
Modifier -78 |
|
A patient has a surgical procedure on Turesday, and later that day the physician must take the patient back to the operating room to repeat (redo) a coronary bypass, due to complications of initial procedure. |
Modifier -76 |
|
If you must use two or more modifiers to describe a service, you would use which modifier to indicate this circumstance? |
Modifier -99 |
|
A surgeon performs a procedure on a neonate weighing 9kg; the procedure was extremely complicated. What modifier would you use to indicate this service, which has an increased level of complexity? |
Modifier -22 |
|
Dr. Storely performed cataract surgery on 10/31/2008 and Dr. Jones provided postoperative care following discharge. What modifier would you use to indicate the postoperative care following discharge? |
Modifier -55 |
|
Dr. Merideth serves as an assistant surgeon to Dr. Taylor. What modifiers; would you add to the procedure code to indicate Dr. Merideth’s status during the procedure? |
Modifier -80 |
|
The third-party payer requires the use of HCPCS/National modifiers; the surgeon performed a surgical procedure on the patient’s left thumb. What Level II modifier would indicate the left thumb? |
Modifier -FA |
|
What Level II modifier indicates the upper left eyelid? |
Modifier -E1 |
|
Which modifier is requests payment for the full fee of the subsequent service because it was unassociated with the first procedure. A new global period should start when modifier _____ is submitted |
Modifier -79 |
|
The CPT manual was developed by the |
American Medical Association (AMA) |
|
Providers of health care are paid based on the codes submitted for _____________ or procedures provided to the patient. |
services |
|
The first CPT was published in this year |
1966 |
|
In which year were CPT codes incorporated as Level I codes into the Healthcare Procedure Coding Sytem (HCPCS)? |
1983 |
|
What type of codes end with 99? |
Unlisted Procedure |
|
Definition of a chief complaint using the E/M Guidelines: |
Chief Complaint is a concise statement describing the symptom, problem, condition, diagnosis, or other factor that is the reason for the encounter, usually stated in the patient’s words. |
|
According to the Surgery Guidelines, surgical destruction is a part of a surgical procedure and ____________ methods of destruction are not ordinarily listed separately. |
different |
|
According to the Radiology Guidelines, who must sign a written report to have the report considered part of the radiologic procedure? |
the interpreting individual |
|
Under whose supervision are the Pathology and Laboratory services provided? |
Physician |
|
What is the code listed in the Medicine Guidelines that is to be used to identify materials supplied by the physician that are beyond those ordinarily included in the service provided? |
99070 |
|
Words following the semicolon in stand-alone codes can indicate the following three things: |
Alternative anatomical sites, alternative procedures, or a description of the extent of the service. |
|
If the CPT code is 43820 (gastrojejunostomy without vagotomy) and two primary surgeons performed the services, the service could be stated this way: |
43820-62 |
|
total |
Anesthesia services are based on ____________time the patient is under the anesthesiologist’s care. Calculation of units of time is determined by the third-party payer. |
|
begins preparing the patient to receive anesthesia, continues through the procedure, and ends when the patient is no longer under the personal care of the anesthesiologist. |
Anesthesia time begins when the anesthesilogist ___________________and continues ______________ the procedure, and ends when ______________________________________________ |
|
qualifying |
What type of circumstance identifies a component of anesthesia service that affects the character of the service? |
|
anatomic |
Anesthesia procedures are divided by what type of site? |
|
complex, combined total (or total time) |
According to the Anesthesia Guidelines, the Separate or Multiple Procedures section, when multiple surgical procedures are performed during a single anesthetic administration, the anesthesia code representing the most ____________ procedure is reported and the time reported is the ________________ or _________________ for all procedures. |
|
Relative Value Guide (RVG) |
What is the name of the guide that is published by the American Society of Anesthesiologists and provdides the weights of various anesthesia services? |
|
expanded problem focused history |
Which history is more complex: The problem focused history or the expanded problem focused history? |
|
problem focused, expanded problem focused, detailed, comprehensive |
The four types of examinations, in order of difficulty (from least difficult to most difficult) are as follows: |
|
problem focused |
The examination that is limited to the affected body area is the ___________ ____________ . |
|
straightforward |
What medical decision making involves a situation in which the diagnosis and management options are minimal, data amount and complexity that must be reviewed are minimal/none, and there is a minimal risk to the patient of complications or death? |
|
Can modifier -22 be assigned to 99291, 99292 codes ( which are E/M service codes) |
No, because it states in the notes for modifier 22 that this modifier should not be appended to an E/M Service |
|
She is incorrect because modifier 32 is only assigned for mandated services, such as police and Workers Compensation and not for requests made by patient, family member, or another physician. |
Joan is a new coder at the local clinic. You have been assigned to review her coding before it is submitted to the third-party payer. You note that she assigned modifier -32 to E/M consultation code 99244. The medical record indicates that the request for the second opinion was made by the patient’s spouse. Is Joan correct in modifier -32 assignment? Why or why not? |
|
b |
Which of these statements is true about modifier -59? a. It is only appended to E/M codes b. It is only appended to other than E/M codes. |
|
c |
Which of the following statemtns is NOT true about modifier -53? a. describes circumstances based on the patient’s condition. b. may be used to describe those times when the physician elects to terminate a procedure due to the well-being of the patient. c. describes circumstances in which the patient cancelled the procedure. d. may be used to describe ASC reporting of previously scheduled procedure that is partially reduced as a result of extenuating circumstances. |
|
a |
When adding multiple CPT modifiers to a code, you would list the modifiers from: a. highest to lowest b. lowest to highest c. makes no difference which is listed first. |
|
What is the word that means assigning multiple codes when one code would do? |
unbundling |
|
Term that describes services provided to the patient by the physician BEFORE surgery |
Pre-operative |
|
Term that describes services provided to the patient by the physician AFTER surgery |
Post-operative |
|
Unlisted procedure codes in the surgery guidelines are listed by…? |
anatomic site |
|
Includes an adequate definition or description of the nature, extent, need, time, effort, and equipment necessary to provide the service |
Pertinent information in the "special report"according to the CPT manual |
|
There two types of procedures that are designated for the purpose of a surgical package |
Minor and major procedures |
|
CPT code for surgical tray |
99070 |
|
HCPCS code for surgical tray |
A4550 |
|
This type of anesthesia is not part of the surgical package |
General anesthesia |
|
Inclusion or exclusion of a procedure in the CPT does or does not imply health insurance coverage or no health insurance coverage? |
coverage is not implied; the CPT manual is a list of procedures and services with a corresponding number only |
|
According to Surgery guidelines, codes designated as separate procedure…? |
should not be reported in addition to the code for the total procedure or service of which it is considered an integral component. |
|
According to medicare guidelines ____ complications of a surgical procedure are usually included in the reimbursement for a major surgical procedure |
Minor complications |
|
The subsections in the surgery section are usually divided according to…? |
Medical specialty or body |
|
Information within parentheses is referred to as…? |
Parenthetical Expression or Phrase |
|
Before assigning this type of code, you must be certain that a more specific Category 1 or Category 3 code is not available |
unlisted procedure code |
|
This designation within the CPT indicates a procedure that is only reported when it is performed as the only procedure or when another procedure performed at the same time is unrelated to this procedure? |
Separate procedure |
|
Can modifier 57 decision for surgery be added to surgery section codes? |
No, only to Evaluation and Management codes |
|
Modifier 54 surgical care only notifies the insurance company to |
pay for the intra-operative portion |
|
true or false? Listing of subsections that have instructional notes is not included in the surgical section guidelines? |
true |
|
Before you can assign an unlisted code, you must first be certain there is no more specific code and that there is not a…? |
Category 3 code available |
|
When using an unlisted or Category 3 code, third-party payers usually require the submission of what? |
Special report |
|
Synchronous means |
occurring at the same time |
|
In the ICD-9-CM manual symbols, abbreviations, punctuation, and notations are termed…? |
Conventions |
|
List the four cooperating parties that agree on coding principles: |
Centers for Medicare and Medicaid Services (CMS), American Medical Association (AMA), American Health Information Management Association (AHIMA), National Center for Health Statistics (NCHS) |
|
true or false? A code is invalid if it has not been coded to the full number of digits available for the code |
true |
|
true or false? It is acceptable to use only the Alphabetic Index to assign ICD-9-CM codes |
False |
|
true or false? When separate codes exist to identify acute and chronic conditions, the chronic code is sequenced first |
False |
|
true or false? In the outpatient setting, an impending condition should be coded as if it actually exists? |
False |
|
true or false? Additional signs and symptoms that may not routinely be associated with the disease process being reported should be coded when present |
true |
|
Identify the main_____ in the diagnostic statement |
terms |
|
Review any_______ under the main term in the index |
subterms |
|
Follow any _______-________ instructions, such as see also |
cross-references |
|
refer to any instructional notations in the |
Tabular |
|
Code the diagnosis until all _______ are completely identified |
elements |
|
Mr Jones is admitted to the hospital by the orthopedic surgeon for severe hip pain. The ortho surgeon provides an initial hospital visit during which it is determined that Mr. Jones has a fractured hip that will require surgical intervention. Mr. Jones is taken later that day to the OR where Dr. Ortho performs the surgical procedure to repair Mr. Jones’ hip. Which modifier would you use for the hosptial visit |
-57 |
|
Mrs Smith presented to her physician’s office for an office visit for an upper respiratory infection. The physician examines that patient and prescribes antibiotics. The physician notices the patient has a suspicious looking mole. The physician examined the mole and determined that is should be removed. The mole was removed during the same office visit. The physician bills both the E/M code and a procedure code. Which modifier would you use on the E/M code |
-25 |
|
Procedures that are experimental, newly approved, or seldom used are reported with what type of code? |
unlisted/category III |
|
Modifier -57, decision for surgery, is used on what type of service? |
E/M |
|
Modifier -79, unrelated procedure or service by the same physician during the postoperative period, is used on what type of service? |
surgery |
|
Modifier -51, Multiple Procedure, is used on what type of services? |
surgery |
|
Modifier -80, Assistant Surgeon, is used when: |
a second surgeon provides assistance to the primary surgeon |
|
Modifier -32 is used to indicate a service is mandated. Which of the following is an example of when a service is "mandated?" |
An insurance company requires a second opinion prior to surgery |
|
Modifier -25, significant, separately identifiable E/M service by the same physician on the same day of the procedure or other service, is used to report an E/M service that was: |
provided on the same day as a minor procedure performed by the same physician |
|
Modifier -59, distinct procedure service, is used to indicate that: |
services that are usually bundled into one payment were provided as separate services |
|
Modifier -58, staged or related procedure or service by the same physician during the postoperative period, is used to indicate: |
that a subsequent surgery was planned at the time of the first surgery |
|
Modifier -52, reduced services, is used to indicate: |
a service was reduced without changing the definition of the code |
|
Modifier -90 |
indicates that services of an outside laboratory were used. Hint: Modifier -90 indicates that services of an outside lab were used. See page 275 of the textbook or Appendix A of the CPT® manual. |
|
Mr. Coslett has multiple surgeries performed during the same operative session. Which modifier would you use? |
modifier -51 |
|
The modifier that indicates multiple procedures is: |
modifier -51 |
|
Anesthesia code for a tympanostomy of the left ear performed on an 11-month-old female. CPT Codes: 00126, 99100. |
CPT Codes: 00126, 99100. |
|
Physical status modifier P3 indicates a patient with a(n) ________ systemic disease. |
Severe |
|
Mr. Jones is admitted to the hospital by the orthopedic surgeon for severe hip pain. The ortho- surgeon provides an initial hospital visit during which it is determined that Mr. Jones has a fractured hip that will require surgical intervention. Mr. Jones is taken to the OR later that day and Dr. Ortho performs the surgical procedure to repair Mr. Jones’ hip. Which modifier would you use for the hospital visit? Modifier -57 |
Modifier -57 |
|
Assign a CPT anesthesia code for debridement of third-degree burns of right arm, 6% body surface area. CPT Code: 01952. |
CPT Code: 01952 |
|
________ of the CPT manual lists some HCPCS modifiers. Appendix A |
Appendix A |
|
The society that publishes the Relative Value GuideTM for anesthesia services is the: |
American Society of Anesthesiologists |
|
Moderate or ________ sedation is a type of sedation that may be provided by the physician performing the procedure. Conscious |
Conscious |
|
Modifier -58, staged or related procedure or service by the same physician during the postoperative period, is used to indicate: that a subsequent surgery was planned at the time of the first surgery. |
that a subsequent surgery was planned at the time of the first surgery. |
|
Which codes begin with the number 99 and are used to indicate anesthesia services provided during situations that make the administration of the anesthesia more difficult? Qualifying Circumstances |
Qualifying Circumstances |
|
What modifier would you use if you were coding only the technical component of a diagnostic procedure? Modifier: TC |
Modifier: TC |
|
In the Anesthesia section of the CPT manual, the codes are usually divided first by which of the following? |
Anatomic Site |
|
Modifier -59, distinct procedure service, is used to indicate that: |
services that are usually bundled into one payment were provided as separate services. |
|
Assign a CPT anesthesia code and applicable modifiers for anesthesia services for a 9- month-old normal child who received anesthesia for hernia repair in the lower abdomen. CPT Code: 00834-P1. |
CPT Code: 00834-P1 |
|
Mrs. Smith presented to her physician’s office for an office visit for an upper respiratory infection. The physician examines the patient and prescribes antibiotics. The physician notices the patient has a suspicious looking mole. The physician examined the mole and determined that it should be removed. The mole was removed during the same office visit. The physician bills both an E/M code and a procedure code. Which modifier would you use on the E/M code? |
Modifier -25 |
|
Modifier -51, Multiple Procedure, is used on what type of services? |
Surgery |
|
Modifier -80, Assistant Surgeon, is used when: |
A second surgeon provides assistance to the primary surgeon. |
|
Daily hospital management of epidural, continuous drug administration. CPT Code: 01996. |
CPT Code: 01996 |
|
Assign a CPT anesthesia code and applicable modifiers for anesthesia services for an 81-year-old patient with mild systemic disease who receives anesthesia for revision of total hip arthroplasty. CPT Codes: 01215-P2, 99100 |
CPT Codes: 01215-P2, 99100 |
|
When time is calculated for anesthesia services, the time begins when the anesthesiologist begins preparing the patient for anesthesia. |
the anesthesiologist begins preparing the patient for anesthesia. |
|
What type of nurse can administer anesthesia under the direction of an anesthesiologist? |
CRNA |
|
Modifier -79, unrelated procedure or service by the same physician during the postoperative period, is used on what type of service? |
Surgery |
|
What modifier would you use if you were coding only for the professional component of a diagnostic procedure? |
Modifier: -26 |
|
The modifier"-AA" is an example of what type of modifier? HCPCS |
HCPCS |
|
1.the more the complex subsection referred to in the text were Integ, Musculo, resipratory, Cardio, Digestive, and |
Female genital |
|
2. The info in the ___ contains info that is necessary to correctly code in the section, & the info is not repeated elsewhere |
Guidelines |
|
3.Notes may appear before subsec, subhead, ___ & subcategories |
Categories |
|
4. when a note is present, that note must be read and ___ if the coding is to be accurate |
Followed |
|
5. w/in the surgery Guidelines the ___ procedure codes are presented in a list by anatomic site |
Unlisted |
|
6. according to the CPT maunal "Pertinent info [in the ___ report] should include an adequate def. or description of the nature, extent, need, time, effort, and equip. necessary to provide the service |
Special |
|
7. there are minor and ___ procedure designations for the purposes of a surgical package |
Major |
|
8. the breast biopsy and mastectomy of the left breast were preformed during the same operative session would both procedures be reported |
Yes |
|
9. if a breast and right knee operation were preformed during the same operative session would both procedures be reported |
Yes |
|
10. The CPT manual describes the surg. pkg as including one related preop E/M service the operative procedure, and immediate ____ care |
Follow up care |
|
11. Local infiltration is considered ___ anesthesia |
Local |
|
12. this term means a worsening as described in the text |
Exacerbations |
|
13. this type of anesthesia is not part of the surgical package |
General anesthesia |
|
14. the predeifined number of days before and after a surgical package |
Global Period |
|
15. what is the CPT code that reports a surgical tray |
99070 |
|
16. what is the HCPCS code that reports a surgical tray |
A4550 |
|
17. according to the medicare guidlines a surg, pkg includes the treatment of complications by the ___ physician |
Same |
|
18. At an off. visit a decision for surgery was made. the surgical procedure was scheduled 21 days later. would the office visit service be |
A. reported separtely |
|
19. Splitting open of the wound is |
Dehiscence |
|
20. Inclusion or exclusion of a procedure in the cpt manual implies health insurance coverage or no health insurance coverage |
True |
|
21. the code range in the surgical section is |
10021-69990 |
|
22. the subsection that follows the digestive system is the ___ system |
Urinary |
|
23. what type of microscope has a section of the surgery section |
Operating scope |
|
24.the difference between 10021 and 10022 is that one is with ___ ____ and one is without |
Imaging guidance |
|
25. according to the parenthetical info following the code 10022 for a precutaneousneedle biopsy other than fine needle aspiration, see ____ for salivary gland |
42400 |
|
26. according to the surgery guidelines codes designated as ____ _____ should not be reported in addition to the code for the totao procedure or service of which it is considered an integral component |
Separate procedure |
|
27. according to the surgery guidelines follow up care for ____ surgical procedures includs only that care which is usually a part of the surgical procedure |
Therapeutic |
|
28. according to the surgery guidelines the code range for maternity care and delivery is |
59000-59899 |
|
29. according to the surgery guidelines this is the code for unlisted procedures of the lip |
40799 |
|
30. according to the surgery guidelines this is the code for unlisted procedures of the urinary system |
53899 |
|
The Coders responsibility is to ensure that the data are as accurate as poosible |
True |
|
The Federal Register is the official publication for all Presidential Docum. |
True |
|
Natioonal unit values have been assigned for each service by Medicare |
True |
|
Fraud is an intentional deception or misrepresentive on that an individual knows to be false or does not believe to be true |
True |
|
Kickbacks from patients are allowed under certain circumstance according to Medicare guidelines |
False |
|
When using an unlisted code a _____must accompany the claim |
C. Special Report |
|
The surgical package includes: |
B. Typical follow-up Care |
|
Local anesthesia is defined in the CPT guidelines as |
D. All of the above |
|
The usual global surgery period for a major procedure is |
D. 90 Days |
|
The global surgery period includes |
A. All routine preoperative and postoperative care |
|
Incision and drainage codes are divided into subcategories according to the |
B. Condition for which the procedure is performed |
|
When an excision is being performed the ‘margins" refer the ______required to adequately excise the lesion based on the physicians judgment |
B. Narrowest margin |
|
What two items are needed to correctly code for local treatment of burns? |
C. Percentage of body surface and depth of burn |
|
This information is placed after some codes in the CPT manual and contains helpful information |
A. Parenthetical information |
|
What code is used to report routine postoperative care |
C. 99024 |
|
What are divisions of the surgery sections of CPT based on |
C. Body System |
|
Excision of pilonidal cyst that was a complicated procedure |
C. 11772 |
|
When the words "separate procedure" appear after the descriptor of a code, yoou know which of the following about that code |
C. The procedure was a minor procedure that would only be coded if it was the only service provided |
|
Excision including closure of benign lessons of the skin including this type of anesthesia |
A. Local |
|
The CPT code that is used to report material and supplies by the physician for which no other more specific CPT code exists is: |
A. 99070 |
|
A triangle before a code indicates that the code is or has been |
D. Revised |
|
The incentive to Medicare participating is: |
D. All of the above |
|
Part B services are billed using |
B. ICD-9CM, CPT, HCPCS |
|
Who is the largest third-party payer in the nation |
D. The Government |
|
The physician fee schedule is updated each April 15 and is composed of |
D. All of the above |
|
Medicare sets the payment level for assistants at surgery at a percentage of the fee schedule for the _______surgical services |
A. Global |
|
What are the items that the Medicare beneficiaries are responsible to pay before Medicare will begin to pay for services |
D. Deductibles, premiums, and coinsurance |
|
Medicare funds are collected by |
B. Social Security Administration |
|
Which of the following is NOT a stated goal of the Physician Payment Reform? |
C. Limit provider liabilities |
|
The Medicare prescription drug improvement, and Modernization Act of 2003 established these new benefits available under the Medicare program |
D. Part D |
|
This Program is also known as Medicare Advantage |
C. Part C |
|
The correct code for repairing the following lacerations: 4.2 simple repair of the trunk, 1.3 simple repair of the arm, and 2.8 intermediate repair of the scalp |
D. 12032, 12002-51 |
|
When reporting a staged procedure what modifier is added to the CPT code? |
C. -58 |
|
Destruction of 7 actinic keratoses: |
D. -17000, 17003 x 6 units |
|
Which modifier indicates a significant, separately identifiable E/M service |
A. -25 |
|
If you want to bill the removal of skin tags using codes 11200 and 11201. you would need to know with absolute certainty |
C. The number of tags removed |
|
Mr. Anderson has dropped a hammer on his big toe resulting in the collection of blood beneath the nail |
A. 11740 |
|
Jessica Reynolds is a 33 y/o woman with two children. She has been using implantable contraceptives for five years |
B. 11977 |
|
Suffix meaning a technique involving molding or surgically forming |
C-plasty |
|
Oter layer of skin |
B. epidermis |
|
A graft taken from the patient’s own body is called: |
C. Autograft |
|
IgA, IgD, IgE, IgG, IgM |
I. Immunoglobulins |
|
H2O |
H. Water |
|
FX |
F. Fracture |
|
Hx |
E. History |
|
mmHg |
D. millimeters of mercury |
|
LLL |
Left lower lobe )lung) |
|
grav. 1,2.3 |
A. first, second, third pregnancy |
|
g, gm |
C. gram |
|
mEq |
G. milliequivalent |
|
The words that follow a code number in the CPT manual are called: |
procedure/service descriptor |
|
A code that has all of the words that describe the code that follows is what type of code? |
stand alone |
|
Procedures that are experimental, newly approved, or seldom used are reported with what type of code? |
unlisted/Category III |
|
Who requires a special report with the use of unlisted codes? |
third-party payers |
|
Which of the following represents three of the six elements that a special report must contain? |
nature, extent, need |
|
Which punctuation mark between codes in the index of the CPT manual indicates a range of codes is available? |
hyphen |
|
Which punctuation mark between codes in the index of the CPT manual indicates two codes are available? |
comma |
|
A list of unlisted procedures for use in a specific section of the CPT manual is contained in: |
Guidelines |
|
In which CPT appendix would additions, deletions, and revisions be found? |
Appendix B |
|
In which CPT appendix would all modifiers be found? |
Appendix A |
|
CPT stands for: |
Current Procedural Terminology |
|
Which terms reflects the technological advances made in medicine that are incorporated into the CPT manual? |
revisions |
|
Where is specific coding information about each section located? |
Guidelines |
|
This act mandated the adoption of national uniform standards for electronic transmission of financial and administrative health information. |
HIPAA |
|
What year was CPT first developed and published? |
1966 |
|
Who publishes CPT? |
AMA |
|
Health care providers are ___ based on the codes submitted on a claim form for procedures and services rendered. |
reimbursed |
|
Category I CPT codes have ___ digits |
5 |
|
The universal health insurance form for submission of outpatient services is the: |
CMS-1500 |
|
Which of the following is NOT a reason for the CPT coding system? |
increased reimbursement |
|
What is the function of an add-on code? |
identifies a code that is never used alone |
|
The rules that govern coding in various health care settings are: |
nationally established |
|
How many main sections are in the CPT manual? |
6 |
|
A modifier: |
provides additional information to the third-party payer |
|
An unlisted procedure code: |
ALL OF THE ABOVE: is a procedure or service not found in the CPT manual, is located in the Section Guidelines, is located at the end of a subsection or subheading |
|
How often are Category III codes released? |
twice a year |
|
According to the notes preceding the Category III codes in the CPT manual, the digits of the Category III codes are not intended to reflect the placement of the code in the Category I section of the CPT: |
nomenclature |
|
According to the CPT manual, modifier -91 is not to be used when test are __ to confirm inertial results. |
rerun |
|
According to the E/M guidelines, time is not a descriptive component for the ___ department levels of E/M service. |
emergency |
|
According tothe Radiology Guidelines, these are the methods that qualify as "with contrast." |
intavascularly, intra-articularly, intrathecally |
|
Level II codes are not used in which setting? |
inpatient |
|
Which of the following would be used to code drugs? |
J codes |
|
Name the six basic location methods to locate main terms in the index of CPT. |
procedure/service synonym eponymous anatomic site condition of disease abbreviations |
|
When using an unlisted code a(an) __________ must accompany the claim. |
SPECIAL REPORT |
|
The surgical package includes: |
TYPICAL FOLLOW-UP CARE |
|
Local anesthesia is defined in the CPT guidelines as: |
ALL OF THE ABOVE |
|
This information is placed after some codes in the CPT manual and contains helpful information. |
PARENTHETICAL INFORMATION |
|
What code is used to report routine postoperative care? |
99024 |
|
The usual global surgery period for a major procedure is: |
90 days |
|
The global surgery period include |
all routine post-up and pre-up |
|
Excision including simple closure of benign lesions of the skin include this type of anesthesia |
Local |
|
What are the divisions of the Surgery section based on? |
99070 |
|
When the words "separate procedure" appear after the descriptor of a code, you know which of the following about that code? |
THE PROCEDURE WAS A MINOR PRCEDURE THAT WOULD ONLY BE CODED IF IT WAS THE ONLY SERVICE PROVIDED. |
|
A triangle before a code indicates that the code is or has been: |
revised |
|
Which of the following represents the contents of a surgical package? |
Preoperative, intraoperative, and postoperative services |
|
The correct code for an unlisted procedure for the breast is |
19499 |
|
The modifier reported when a physician component is reported separately is |
-26 |
|
A____ procedure that is performed independently of, and is not immediately related to, another service |
separate |
|
The divisions of the Radiation Oncology section of the CPT manual are divided into subsections based on what |
type of service |
|
What is the standard measure of energy in radiation treatment |
MeV |
|
What is the modifier used to identify the technical component of a radiologic procedure< |
-TC |
|
What are the radioisotopes that attach themselves to red blood cells called |
tracer |
|
What is the name of the high-frequency sound waves in an imaging process that are used to diagnose patient illness |
ultrasound |
|
Radiation oncology codes include normal follow-up care during the course of treatment and for ___ months following its completion |
Includes 3 months global period |
|
Codes 76801 and 76802 include determination of the number of gestational sacs and fetuses, gestational sac/fetal measurements appropriate for gestation <14 weeks 0 days and : |
ALL OF THE ABOVE |
|
A needle with a suture attached is passed through an incision into the stomach. The needle is snared and removed via the mouth. A gastrostomy tube is connected to the suture and passed through the mouth into the stomach and out the abdominal wall. What is the correct code for this procedure |
None of the above |
|
The procedure is a percutaneous transhepatic dilation of the biliary duct stricture with or without placement of a stent. How would the radiological supervision and interpretation be coded? |
74363 |
|
In clinical brachytherapy the superviaion of radio elements and dose interpretation are performed by the therapeutic |
Radiologist |
|
Two dimensional ultrasonic scanning procedure with a two dimendiagnostic ultrasoundsional display is the definition of___ |
B-scan |
|
x-ray films of vessels after injection of radiopaque substance material |
Angiography |
|
Fluoroscopy |
Procedure for viewing the interior of the body using x-rays and projecting the image onto a television screen |
|
Magnetic resonance imaging MRI |
Procedure that uses nonionizing radiation to view the body in a cross-sectional view |
|
Xeroradiography |
Photoelectric process of radiographs |
|
Barium |
Radiographic contrast medium |
|
Biometry |
Application of a statistical method to a biological fact |
|
Arthrography |
Joint |
|
Cholangiography |
Bile Ducts |
|
Cystography |
Veins and tributaries |
|
Discography |
Intervertebral join |
|
Epididymography |
Epididymis |
|
Hysterosalpingography |
Uterine cavity and fallopian tubes |
|
lymphangiography |
Lymphatic vessels and nodes |
|
Myelography |
Subarachnoid space of the spine |
|
Urography |
Kidneys, renal pelvis, ureters, and bladder |
|
Venography |
X-ray image of vein or veins following injection of a radiopaque substance |
|
lymphangiography |
x-ray visualization of lymph vessel and nodes following injection of a contrast material |
|
myelogram |
x-ray phonograph of the spinal cord following administration of radiopaque substance into the subarachnoid space |
|
Tomography |
Also known as PET sca, it measures ametabolic or biochemical activity of the brain and other organs by tracking its movement and concentration |
|
Magnetic resonance |
Noninvasive diagnostic technique that produces a cross-sectional image of organs and other internal body structures |
|
Cholangiography |
x-ray of the bile ducts using radiopaque contrast |
|
Computed tomography |
Also known as a CAT scan, this technique allows safe, painless, and rapid diagnosis in previously inaccessible areas of the body |
|
Pelvimetry |
Measurement of the diameters of the female pelvis, esp. the birth canal |
|
Ultrasound |
The application of ultrasonic waves for diagnostic imaging of internal structures |
|
Anterior (ventral) |
In front of |
|
Posterior (dorsal) |
In back of |
|
Superior |
Toward the head or the upper part of the body: also known as cephalad or cephalic |
|
Inferior |
Away from the head or the lower part of the body; also known as caudad or caudal |
|
Medial |
Toward the midline of the body |
|
Lateral |
Away from the midline ofteh body (to the side) |
|
How many levels of Surgical Pathology are there? |
six |
|
What type of drug test measures the presence of a drug in the specimen? |
qualitative |
|
What type of drug test measures the amount of a drug in the specimen? |
quantitative |
|
What is the name given to grouped laboratory work that represents those tests commonly done together? |
panels |
|
In what section would you find codes used to report veinpunctures and arterial punctures? |
surgery |
|
What is the name of the subsection within Pathology?Laboratory that deals with the laboratory work done to determine cellular changes? |
cytopathology |
|
In the Pathology/Laboratory section of the CPT, drugs are listed by their ____names. |
generic |
|
A specimen from a suspect area can be divided into which of the following? |
block, section |
|
What name is given to cultures for identification of organisms, as well as the identification of sensitivities of the organism to antibiotics? |
culture/sensitivity |
|
Qualitative analysis is defined as: |
analysis of a substance in order to ascertain the nature of chemical constituents. |
|
Quantitative analysis is defined as |
Determining the amounts and proportions of chemical constituents |
|
Codes in the Pathology/Laboratory section, Evocation/Suppression Testing include which of the following? |
Test only |
|
What must always be documented in the patient record and is the major billing factor for reporting codes in the psychiatric subsection. codes divided on time |
time |
|
What word is used to describe the pushing of liquid into the body over a long period of time. |
infusion |
|
Outpatient dialysis services are reported on this basis |
monthly |
|
What is the name of the process that routes the blood including waste products outside the body through filters |
hemodialysis |
|
Aphakia |
absence of the lens of the eye |
|
Echography |
Ultrasound procedure in which sound waves are bounced off an internal organ and the resolution image is recorder |
|
Gonioscopy |
Use of a scope to examine the angles of the eye |
|
Hemodialysis |
Cleansing of the blood outside the body |
|
Modality |
Treatment method |
|
Nystagmus |
Rapid involuntary eye movement |
|
Optokinetic |
pertaining to eye movements |
|
Percutaneous |
pertaining to through the skin |
|
Phlebotomy |
cutting into a vein |
|
Retrograde |
move in a direction contrary to the usual one |
|
Subcutaneous |
tissue below the dermis, primarily fat cells that insulate the body |
|
Tonometry |
use of a tonometer to measure intraocular pressure, which is elevated in glaucoma, method used for detecting glaucoma |
|
Tympanometry |
process of measuring eardrum function |
|
Transcutaneous |
Entering by way of the skin |
|
What is the largest section of the six CPT manual section? |
Surgery section |
|
Does Medicare reimburse for every surgical tray? |
NO |
|
The subsections in the Surgery section are usually divided according to _______. |
Medical specialty or body system. |
|
This symbol indicates new or revised text within the current edition of the CPT manual |
Triangle |
|
These are found at the beginning of each section and contain information specific to the section : |
Guidelines |
|
Information within parentheses is referred to as _____ expression or phrase. |
parenthetical |
|
Before assigning this type of code, you must be certain that a more specific Category I or Category III code is not available |
Unlisted procedure |
|
This report contains the nature, extent, need, time, effort, and at times equipment necessary to provide a service : |
Special reports |
|
This designation within the CPT manual indicates a procedure that is only reported when it is preformed as the only procedure or when another procedure performed at the same time is unrelated to this procedure. this is a ________ procedure. |
… |
|
When time, effort, and service are bundled together, they form a ________ package. |
surgical |
|
_______ anesthesia is defined as local infiltration, metacarpal/ dital block, or topical anesthesia |
Local |
|
Modifier -22 |
Increased Procedural Services |
|
Modifier -23 |
Unusual Anesthesia Modifier |
|
Modifier -24 |
Unrelated E/M Services by the Same Physician During a Postoperative Period |
|
Modifier -25 |
Significant Separately Identifiable E/M Service by the Same Physician on the Same Day of the Procedure or Other Service |
|
Modifier -26 |
Professional Component |
|
Modifier -32 |
Mandated Services |
|
Modifier -47 |
Anesthesia by Surgeon |
|
Modifier -50 |
Bilateral Procedure |
|
Modifier -51 |
Multiple Procedures |
|
Modifier -52 |
Reduced Services |
|
Modifier -53 |
Discontinued Procedure |
|
Modifier -54 |
Surgical Care Only |
|
Modifier -55 |
Postoperative Management Only |
|
Modifier -56 |
Preoperative Management Only |
|
Modifier -57 |
Decision for Surgery |
|
Modifier -58 |
Staged or Related Procedure or Service by the Same Physician During the Postoperative Period |
|
Modifier -59 |
Distinct Procedural Service |
|
Modifier -62 |
Two Surgeons |
|
Modifier -63 |
Procedure Performed on Infants Less than 4 kg |
|
Modifier -66 |
Surgical Team |
|
Modifier -76 |
Repeat Procedure or Service by Same Physician |
|
Modifier -77 |
Repeat Procedure by Another Physician |
|
Modifier -78 |
Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure During the postoperative Period |
|
Modifier -79 |
Unrelated Procedure or Service by the Same Physician During the Postoperative Period |
|
Modifier -80 |
Assistant Surgeon |
|
Modifier -81 |
Minimum Assistant Surgeon |
|
Modifier -82 |
Assistant Surgeon (When Qualified Resident Surgeon Not Available) |
|
Modifier -90 |
Reference (Outside) Laboratory |
|
Modifier -91 |
Repeat Clinical Diagnostic Laboratory Test |
|
Modifier -92 |
Alternative Laboratory Platform Testing |
|
Modifier -99 |
Multiple Modifiers |
|
Surgical Team |
When more than two physicians, with technicians and specialized equipment, work together to complete a complicated procedure and each physician has a specific portion of the surgery to complete, they are term what? |
|
Modifier -22 |
This modifier indicates an increased service and is overused and results in an increase in payment of 20% to 30%. As such, the assignment of this modifier comes under particularly close scrutiny by third-party payers. What is this modifier? |
|
Modifier -54 |
Payment for the intraoperative or surgery portion of the surgical procedure is being requested. |
|
Modifier -59 |
Only to other than E/M codes |
|
What is the weight in pounds of a 4-kilogram infant? |
8.8 lbs. |
|
Modifier -55 |
(Postoperative Management Only) should be assigned when a provider other than the surgeon is responsible for postoperative management. |
|
NCCI |
National Correct Coding Initiative |
|
National Correct Coding Initiative (NCCI) |
Implemented by the American Medical Association |
|
Modifier -52 |
A service that has been partially reduced at the physician’s discretion is reflected by the modifier |
|
Modifiers -23, -52, and -73 |
When the provider performs a procedure or service for which there is no CPT code, the coder should assign |
|
National Correct Coding Initiative (NCCI) |
Automated edits that identify pairs of services that normally should not be billed by the same physician for the same patient on the same day are part of the |
|
What is a functional modifier |
It is a pricing modifier, which means that the third-party payer considers it when determining reimbursement |
|
Modifier -62 |
When two primary surgeons are required during an operative, each performing distinct parts of a reportable procedure, modifier ___________ should be assigned. |
|
Modifier -76 |
When a procedure was repeated because of special circumstances involving the original service and the same physician performed the repeat procedure, modifier ____ should be recorded. |
|
Modifier -32 |
Workers’ Compensation referred a patient to a physician for a mandatory examination to determine the legitimacy of a claim (insurance certification). What modifier would be added to the code for the examination service? |
|
Modifier -47 |
Dr. Ramus administers regional anesthesia by intravenous injection (also known as Bier’s local anesthesia) for a surgical procedure on the patient’s lower arm. Dr. Ramus then performs the surgical procedure. What modifier would be added to the surgical code. |
|
Modifier -25 |
A patient came to the office twice in one day to see the same physician for unrelated problems. What modifier would be added to the code for the second office visit? |
|
Modifier -51 – There are three significant times when multiple procedures are reported: |
1. Same Operation, Different Site 2. Multiple Operation(s), same Operative Session 3. Procedure Performed Multiple Times |
|
Modifier -54, -55, and -56 |
When reporting his or her own individual services, each physician would use the same procedure code for the surgery, letting the modifier indicate to the third-party payer the part of the surgical package that each personally performed. |
|
Appendix A |
What appendix in the CPT manual contains a complete list of all modifiers? |
|
Preoperative Services |
What is the term that describes the services provided to a patient by the physician before surgery? |
|
When listing multiple CPT modifiers, you would list them from: |
Highest to lowest |
|
Which of the following statements is true about modifier? |
may be used to describe those times when the physician elects to terminate a procedure due to the well-being of the patient |
|
Dr. Wells began surgery on an 86-year-old female with severe hypertension. The patient was satisfactorily anesthetized and the site opened to view. Shortly thereafter, the patient’s blood pressure dropped significantly, and the physician was unable to stabilize the patient. The procedure was discontinued. |
Modifier -53 |
|
The patient is a 10-month-old boy who fell while trying to walk. He cut the bottom of his lip open. Sutures are necessary, but due to the patient’s age and excessive movement, general anesthesia is needed. |
Modifier -23 |
|
A patient has a hernia repair and 2 days later must be returned to the operating room for a dehiscence of the incision. When coding the secondary hernia repair, which modifier would you add onto the surgical codes? |
Modifier -78 |
|
A surgeon performed a repair of an enterocele using an abdominal approach and reported the service with 57270. Then patient was morbidly obese with a BMI of 42, and due to this circumstance, the procedure took a significant amount of additional time to perform. |
Modifier -22 |
|
During a radical right descended orchiectomy for an extensive malignant tumor (54435), the patient began to hemorrhage. After considerable time and effort, the hemorrhage was controlled. |
Modifier -22 |
|
The modifier -RT and LT are: |
Right and Left, Never used with Modifier -50, and HCPCS modifiers |
|
Which group of modifier, are most likely NOT to be recognized by insurance carriers? |
Modifiers -63, -53, -54, -55, and -56 |
|
Modifiers -54 and -55 most likely would be used. |
By two different physicians, on separated claims |
|
Modifier -TC means: |
Technical Component |
|
Adding modifier ______________, Unusual Services modifier, indicates "additional effort or time": |
Modifier -22; May still not be compensated at a higher rate, even with a report, if the carrier doesn’t agree. |
|
The modifier -23, ____________ would not be appropriate for the use of a accupuncture |
Unusual anesthesia |
|
Modifier -24 should always be used with: |
Evaluation and Management codes. |
|
Modifier -25 |
Used for the initial evaluation of a problem for which a procedure is performed. |
|
If general anesthesia is applied, modifier -23 should be used when your CPT manual notes under the CPT code: |
Procedure "usually performed without anesthesia or under local anesthesia." |
|
Some CPT codes are "Technical Service only". This means: |
Only the "facility", most often a hospital, would bill for services (use of the equipment.) |
|
The use of a magnifying surgical loupe qualifies the use of modifier -20, microsurgery: |
Modifier -20 has been deleted from CPT and can no longer be used. |
|
Which of the following modifiers are considered informational only (will not impact reimbursement)? |
Modifiers -24, -32, and -57 |
|
What the percentage amounts allocated for Modifier -54, -55, and -56, respectively? |
70%, 20%, 10% |
|
What the percentage amounts for modifier -54? |
Intraoperative: 70% |
|
What the percentage amounts for modifier -55? |
Postoperative: 20% |
|
What the percentage amounts for modifier -56? |
Preoperative: 10% |
|
What is the word that means assigning multiple codes when one code would do? |
Unbundling |
|
What is another term for the time after the surgery that the physician provides services to the patient? |
Postoperative Services |
|
A patient is admitted and has bilateral arthroscopy of the knees due to Baker’s cysts. |
Modifier -50 |
|
A radiological examination of the gastrointestinal tract was ordered by a third-party payer for a confirmation of Crohn’s disease (regional enteritis) of the large bowel. |
Modifier -32 |
|
Anesthesia provided by the ENT physician during a tympanoplasty for repair of a tympanic membrane perforation. |
Modifier -47 |
|
A patient is seen at the direction of Workers’ Compensation for a complete physical examination for insurance certification. |
Modifier -32 |
|
The patient returns to the operating room for removal of deep pins during the postoperative period, due to complication (dislodged) after an open repair of a humerus fracture. |
Modifier -78 |
|
A patient has a surgical procedure on Turesday, and later that day the physician must take the patient back to the operating room to repeat (redo) a coronary bypass, due to complications of initial procedure. |
Modifier -76 |
|
The patient underwent a bilateral tympanoplasty. |
Modifier -50 |
|
If you must use two or more modifiers to describe a service, you would use which modifier to indicate this circumstance? |
Modifier -99 |
|
A surgeon performs a procedure on a neonate weighing 9kg; the procedure was extremely complicated. What modifier would you use to indicate this service, which has an increased level of complexity? |
Modifier -22 |
|
Dr. Storely performed cataract surgery on 10/31/2008 and Dr. Jones provided postoperative care following discharge. What modifier would you use to indicate the postoperative care following discharge? |
Modifier -55 |
|
Dr. Merideth serves as an assistant surgeon to Dr. Taylor. What modifiers; would you add to the procedure code to indicate Dr. Merideth’s status during the procedure? |
Modifier -80 |
|
The third-party payer requires the use of HCPCS/National modifiers; the surgeon performed a surgical procedure on the patient’s left thumb. What Level II modifier would indicate the left thumb? |
Modifier -FA |
|
What Level II modifier indicates the upper left eyelid? |
Modifier -E1 |
|
Which modifier is requests payment for the full fee of the subsequent service because it was unassociated with the first procedure. A new global period should start when modifier _____ is submitted |
Modifier -79 |
|
procedure/service coding reference developed by CMS |
Health care common procedure coding system (hcpcs) |
|
Two levels of codes are asscoiated with hicpcs , referred to as |
hcpcs level I and II codes |
|
HCPCS level I includes the 5 digit CPT codes developed & published by |
American Medical Association (AMA) |
|
HCPCS level II were created in 1983 to describe |
common medical services & supplies not classified in CPT |
|
HCPCS level II national codes |
are 5 characters in length & begin with letters A-V |
|
HCPCS level II codes identify services performed by |
physician & nonphysician providers, ambulance companies, & Durable Medical Equipment (DME) companies |
|
Durable Medical Equipment (DME) |
defined by Medicare as equp. that can withstand repeated use, is primarily used to serve a medical purpose, is used in the patient’s home & would not be used in the absence of illness or injury |
|
When an appropiate HCPCS level II code exisits |
it is often assigned instead of a CPT code (with the same or simialr code description for MEDICARE accounts & for some state Medicaid systems |
|
Coders should check with |
individual payers to determine their policies |
|
CMS creates |
HCPCS level II codes |
|
New HCPCS level II codes are reported for several years untill |
CMS initiates a process to create corresponding CPT codes |
|
When CPT codes are published they are reported |
instead of the original HCPCs level II codes |
|
Medicaid Programs use HCPCS codes to report |
professional services , procedures, supplies, & equipment |
|
HCPCS is NOT a reimbursement methodology or system, & it is important |
to understand that just because codes exist for certain procedures or services, coverage (payment) is not guaranteed |
|
it ensures uniform reporting of |
medical procedures or services on claim forms |
|
code descriptors identify |
similar products or services |
|
HCPCS is not a reimbursement methdology for making |
coverage or payment determinations |
|
Effective JAN. 1st 2005, CMS no longer allows |
90 day grace period for reporting discontinued, revised and new HCPCS level II national codes on claims |
|
Types of HCPCS level II codes |
permanent national codes, dental , misc., temp. codes, & modifiers |
|
HCPCS level II Permanent national codes are maintained by HCPCS national panel, which is composed of |
representitves form Blue Cross/Shield Asscociation, Health Insurance of America and CMS |
|
HCPCS national Panel I responsible for making decisions about |
additions, revisions, and deletions to the permanent national alphanumeric codes |
|
dental codes |
actually contained in Current Dental erminology , a coding manual copyrighted and published by the American Dental Association that lists codes for billing for dental procedures and supplies |
|
Miscellanous codes |
reported when a DMEPOS dealer submits a claim for a product or service which there’s no exsiting HCPCs level II code |
|
Claims that contain miscellanous codes are |
manually reviewed by the payer |
|
Following must be provided for use in the review process |
Complete description of product or service, Pricing info for product of service, Documentation to explain why the item or service is needed by the benificery |
|
Temporary codes |
maintianed by CMS & other members of the HCPCS national panel, independent of permanent HCPCS level II codes |
|
Permanent codes are updated once a year on Jan 1st but temp. codes allow |
payers the flexibility to establish codes that are needed before the next jan. 1st anual update |
|
Codes are used exclusivley for OPPS purposes & are only valid for |
Medicare claims submitted by hospital outpatient departments |
|
HCPCS modifiers are reported as |
to digit character alphabetic or alphanumeric codes added to the 5 character HCPCs level II code |
|
ex: Modifier -UE indicates |
product is "used equipment" |
|
AA |
anesthesia services performed personally by anesthesiologist |
|
C codes are reported for |
new drugs, bilogicals, & devices that are eligible for transitional passthrough payments |
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It is important never to code directly from the |
index & always to verify the code in the tabular section of the coding manual |
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If you have difficulty locating the service or procedure in the HCPCS level II index |
review the contents of the appropiate section to locate the code |
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HCPCS level II code determines wheter the claim is sent to the |
local Medicare administrative contractor or the regional |
|
Unless the payer or insurance plan adivises the provider that it does not pay seperatly for the |
medication injected, always report this combination of codes |
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Medicare gives HCPCS level II codes the highest priorty if the CPT code is |
general & the HCPCS level II code is more specific |
|
Most supplies are included in the charge for the |
office visit or the procedure |
|
CPT providers code 99070 for all supplies & materials exceding those |
usually included in the primary service or procedure performed |
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