HCPCS Level II Exam Questions And Answers Graded A+!!!

The HCPCS codes are - ANS 5 digits The first digit is a letter, followed by four numbers. The codes and descriptions are updated each year by CMS. The HCPCS Level II uses several symbols and conventions to alert coders to - ANS key pieces of information related to code assignment and/or reimbursement. Examples include the - ANS identification of new, revised, deleted, and reinstated codes and the identification of codes that represent services not covered by Medicare. The meaning of the symbols is explained in the HCPCS book and - ANS the symbols and their descriptions are also included in the lower margins of the pages of the HCPCS Tabular List for ease of reference. Special Coverage Instructions (sun) - ANS This symbol indicates that special coverage instructions apply to the code. Coders should consult the coverage instructions before assigning the code. The special instructions are usually included in CMS' Internet Only Manuals (IOM). References to the location of the IOM are presented in the form of Medicare Pub 100 reference numbers. Not Covered or Valid by Medicare -(red crossed out) - ANS This symbol indicates that the service, procedure, or item represented by the code is not covered by Medicare. The reason for non-coverage is also usually included in CMS' Internet Only Manuals (IOM). carrier discretion (flower) - ANS This symbol indicates that the third party payer must be consulted to determine the coverage that will be provided for the service or supply represented by the code. ASC/OPPS Status Indicators - - ANS The ASC status indicators identify how a specific procedure, item, or service is paid or not paid under the OPPS. ASC Payment Indicators- - ANS The ASC payment indicators identify how the ASC payment for a specific procedure, item, or service is derived under the ASC payment system. Locate the code G9091. Which of the following is true about the ASC Status Indicator listed? - ANS indicates codes not allowed or paid under OPPS The ASC Payment Indicator of N1 is listed beside code C9738. How is the payment for this service determined? - ANS packaged service or item The ASC Payment Indicator listed after the code C9725 indicates which of the following? - ANS paid under OPPS; separate APC payment The ASC Status Indicator to the right of code J7307 indicates which of the following? - ANS payment is not allowed under the OPPS The ASC payment indicator listed after the code J1670 indicates which of the following? - ANS payment based on OPPS rate DMEPOS - (wheelchair) - ANS DMEPOS stands for durable medical equipment, prosthetics, orthotics and supplies. Codes with this symbol indicate items that may be eligible for payment from CMS. Alternative Drug Names - - ANS Beside each code for drug administration in the "Tabular List" is a code description containing the name of the drug being administered. Most drugs have at least one alternative drug name (e.g., generic vs brand). Alternative names that a drug may also be referenced by are listed below the code description in the tabular list. NDC - - ANS This symbol highlights alternative drug names that are eligible for payment under Medicare part B. Merit Based Incentive Payment System (MIPS) - - ANS This symbol indicates that a code has been included in MIPS Quality Measure Specifications. MIPS allows clinicians to earn performance-payment adjustments under CMS' Quality Payment program. new - ANS green triangle or black circile revised - ANS revirse sign or black triangle deleted - ANS crossed out reinstalled - ANS blue check or white circle Reimbursement for some HCPCS codes is limited to a specific number of units per date of service. These limits are based on - ANS CMS' Medically Unlikely Edits (MUEs). MUEs - ANS are edits that put limits on the number of times a procedure, service or supply will be reimbursed on the same date of service because, as their name suggests, CMS has determined it is unlikely it is medically necessary for that procedure, service or supply to be provided in an amount in excess of the amount outlined in the edit for a single date of service. MUEs can be reviewed through several sources including - ANS CMS' Internet Only Manuals (IOMs). Quantity Alert Physician/Provider -(green square says Qp) - ANS This symbol indicates that there is a maximum number of allowable units of service, per patient, per day that can be billed by the provider. Quantity Alert Hospital Outpatient (orange square says Qh)- - ANS This symbol indicates that there is a maximum number of allowable units of service that can be billed per day, per hospital outpatient.