HCPCS Level II Coding Questions and Answers 2024;full solution pack

An advance beneficiary notice (ABN) - a waiver signed by the patient acknowledging that because medical necessity for a procedure, service, or supply cannot be established (e.g., due to the nature of the patient's condition, injury, or illness), the patient accepts responsibility for reimbursing the provider or DMEPOS dealer for costs associated with the procedure, service, or supply. C codes - permit implementation of section 201 of the Balanced Budget Refinement Act of 1999, and they identify items that may qualify for transitional pass-through payments under the hospital outpatient prospective payment system (OPPS). C codes - reported for new drugs, biologicals, and devices that are eligible for transitional passthrough payments under the ambulatory payment classifications (APCs) under the outpatient prospective payment system. certificate of medical necessity (CMN) - prescription document for durable medical equipment, services, and supplies that is signed by the treating physician and submitted with the CMS-1500 claim to the DME MAC for reimbursement. characteristics of HCPCS level II codes - five characters in length, and they begin with letters A-V, followed by four numbers. Claims that contain miscellaneous codes are manually reviewed by: _____ - the payer; provided for use in the review process: -Complete description of product or service; -Pricing information for product or service; -Documentation to explain why the item or service is needed by the beneficiary. CMS creates HCPCS level II codes: - -For services and procedures that will probably never be assigned a CPT code (e.g., medications, equipment, supplies); -To determine the volumes and costs of newly implemented technologies.CMS HCPCS Workgroup - develop and maintain HCPCS level II; composed of representatives from CMS, Medicaid State agencies, the Veterans Administration, and the Medicare Pricing, Data Analysis and Coding (PDAC) contractors. D codes - copyrighted by the American Dental Association, and the codes are included in the HCPCS Level II Professional publication. DME MACs - process Medicare durable medical equipment (DME) claims for defined geographic areas. Durable medical equipment (DME) - defined by Medicare as equipment that can withstand repeated use, is primarily used to serve a medical purpose, is used in the patient's home, and would not be used in the absence of illness or injury. Durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) - include artificial limbs, braces, medications, surgical dressings, and wheelchairs. Durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) dealers - supply patients with durable medical equipment (DME) (e.g., canes, crutches); submit claims to DME Medicare administrative contractors (MACs) who are awarded contracts by CMS. G codes - identify professional health care procedures and services that do not have codes identified in CPT. G codes are reported to all payers.