214 CPT, HCPCS Exam 1 Wk 1&2, Ch.
1,2,3,7 Questions and Answers
What organization is responsible for updating CPT codes - ANS-American Medical
Association
What organization is responsible for maintaining HCPCS level II Codes - ANS-Centers
for Medical Services
What code set describels medical necessity - ANS-ICD-10-CM
Dr Smith saw a medicare pt. w/ a dx of rectal abscess in Certral Hospital. She
performed an incision and drainage in the outpatient surgery department.
Which coding system describes the rectal abscess?
Which would hospital use to bill for surgical services?
Which would Dr. Smity use to report surgical services? - ANS-ICD
CPT
CPT
Place a mark in front of all dx. that would support medical necessity for CPT code
92550- tympanometry and reflex threshold measurement - ANS-All but paralysis
What type of code will hospital use on billing form to represent the diagnosis? - ANS-
ICD-10-CM
Which of the following procedures/supplies/services could not be assigned a code from
CPT?
a. glucose lab
b. anesthesia for appendectomy
c. xray of right foot
d. supply patient w/ crutches
e. appendectomy - ANS-d. supply patient with crutches: I think this would be a HCPCS
code, but not sure
Which identifies as HCPCS level II code?
0030T
L3381
4003F
36491 - ANS-L3381 : level II always has an alpha as 1st character, followed by 4
numerals
, Who publishes and maintains the CPT manuel? - ANS-AMA American Medical
Association
Which type of billing form does the hospital submit codes on? - ANS-UB-04
When using unlisted CPT code, what must be sent to third party payer along with CMS
1500 form? - ANS-Written report describing service- usually an operative report will be
sufficient
Standard form used by providers to submit paper cliams to Medicare Part B and many
private health insurance companies. - ANS-CMS 1500
Name 3 purposes for CPT - ANS-Reimbursement
Trending/planning outpatient/ambulatory services
Benchmarking for comparing similar providers and facility for quality improvment
Assess and imiprove quality of care for patient
Complexity of medical decision making is based on what 3 elements - ANS-1. # of
diagnosis and treatment options
2. amount & complexity of data to review
3. risk- mortality/morbidity
Category 1
Category 2
Category 3 - ANS-E/M, anesthes., surgery, radiology, path, lab, medicine
performance measures
emerging technology
HCPCS - ANS-2 part system developed by CMS to standardize coding system used to
process medicare claims
used for all services, supplies, materials, injections
Level 1 - ANS-CPT Codes (80% of HCPCS can be coded using CPT
Level II - ANS-National Codes
3 KEY Components of E/M - ANS-History
Exam
Medical Decision Making
4 contributory elements in addition to the 3 KEY components - ANS-counseling
coordination of care
nature of presenting problem
time
1,2,3,7 Questions and Answers
What organization is responsible for updating CPT codes - ANS-American Medical
Association
What organization is responsible for maintaining HCPCS level II Codes - ANS-Centers
for Medical Services
What code set describels medical necessity - ANS-ICD-10-CM
Dr Smith saw a medicare pt. w/ a dx of rectal abscess in Certral Hospital. She
performed an incision and drainage in the outpatient surgery department.
Which coding system describes the rectal abscess?
Which would hospital use to bill for surgical services?
Which would Dr. Smity use to report surgical services? - ANS-ICD
CPT
CPT
Place a mark in front of all dx. that would support medical necessity for CPT code
92550- tympanometry and reflex threshold measurement - ANS-All but paralysis
What type of code will hospital use on billing form to represent the diagnosis? - ANS-
ICD-10-CM
Which of the following procedures/supplies/services could not be assigned a code from
CPT?
a. glucose lab
b. anesthesia for appendectomy
c. xray of right foot
d. supply patient w/ crutches
e. appendectomy - ANS-d. supply patient with crutches: I think this would be a HCPCS
code, but not sure
Which identifies as HCPCS level II code?
0030T
L3381
4003F
36491 - ANS-L3381 : level II always has an alpha as 1st character, followed by 4
numerals
, Who publishes and maintains the CPT manuel? - ANS-AMA American Medical
Association
Which type of billing form does the hospital submit codes on? - ANS-UB-04
When using unlisted CPT code, what must be sent to third party payer along with CMS
1500 form? - ANS-Written report describing service- usually an operative report will be
sufficient
Standard form used by providers to submit paper cliams to Medicare Part B and many
private health insurance companies. - ANS-CMS 1500
Name 3 purposes for CPT - ANS-Reimbursement
Trending/planning outpatient/ambulatory services
Benchmarking for comparing similar providers and facility for quality improvment
Assess and imiprove quality of care for patient
Complexity of medical decision making is based on what 3 elements - ANS-1. # of
diagnosis and treatment options
2. amount & complexity of data to review
3. risk- mortality/morbidity
Category 1
Category 2
Category 3 - ANS-E/M, anesthes., surgery, radiology, path, lab, medicine
performance measures
emerging technology
HCPCS - ANS-2 part system developed by CMS to standardize coding system used to
process medicare claims
used for all services, supplies, materials, injections
Level 1 - ANS-CPT Codes (80% of HCPCS can be coded using CPT
Level II - ANS-National Codes
3 KEY Components of E/M - ANS-History
Exam
Medical Decision Making
4 contributory elements in addition to the 3 KEY components - ANS-counseling
coordination of care
nature of presenting problem
time
