HCPCS, ICD, CPT, and CMS-1500
(chapter 8 & 11) Exam
HCPCS codes - ANS-generally for products, supplies, and services, things like
ambulance services, durable medical equipment, prosthetics, and orthotics that aren't
represented by CPT codes; ensure uniform reporting of medical products or services on
claims
excludes1 - ANS-not coded here
excludes2 - ANS-Not included here
modifiers are appended to CPT codes in order to: - ANS-clarify the procedure or service
to go directly to the table of neoplasms, you must know ___ and the ___ of the
neoplasm. - ANS-classification, site
reporting lesion excision requires: - ANS-knowing the size including the margins or the
lesion, and knowing whether the lesion is benign or malignant
What are the key components of E/M? - ANS-1. History
-Chief complaint
-History of Present illness
-Review of Symptoms
-Past, Family and Social History
2. Physical Exam
3.Medical Decision Making Complexity
in what section of CPT are lesion removal codes found? - ANS-surgery
HCPCS level II codes are also known as: - ANS-permanent national codes
when there is a CPT code and a HCPCS level II code available to report a service,
which code should be reported? - ANS-depends on payer policy
miscellaneous codes - ANS-national codes used when a supplier is submitting a bill for
an item or service where no existing national code exists to describe the item or service
being billed
transitional pass-through payments - ANS-temporary additional payments (above the
OPPS reimbursement rate) made for certain innovative medical devices, drugs, and
biologicals provided to Medicare beneficiaries.
, temporary codes - ANS-maintained by the CMS and other members of the HCPCS
National Panel; independent of permanent national codes; allow payers the flexibility to
establish these codes as needed before the next January 1 annual update
The specific HCPCS Level II code determines whether a specific claim is sent to the
MAC that processes provider claims or the ___ ___that processes DMEPOS dealer
claims. - ANS-DME MAC
Annual lists of valid HCPCS Level II codes are obtained by providers and DMEPOS
dealers. They include ______ instructions for services as well. - ANS-billing
CMS decided to have all DME claims processed by one of four DME MACs to reduce
_________ claims. - ANS-fraudulent; DME MACs specialize in the development of
coding guidelines and verification of appropriate coding for these services.
Two claims are generated when a physician treats a Medicare patient for a fractured
femur and supplies the patient with crutches. The physician's claim for the fracture
treatment is sent to the MAC, and the claim for the supply of crutches is sent to the
_____ _____. - ANS-DME MAC
For certain items or services reported on a claim submitted to the DME MAC, the
DMEPOS dealer must receive a signed _____________. - ANS-certificate of medical
necessity (CMN)
HCPCS level II was introduced in 1983 after Medicare found that its payers used more
than 100 different coding systems, making it _____. - ANS-difficult to analyze claims
data
HCPCS furnishes health care providers and suppliers with a _____ language for
reporting professional services, procedures, supplies, and equipment. - ANS-
standardized
Although the majority of procedures and services are reported using CPT (HCPCS level
I), that coding system does not describe _____ (services) and certain other services
reported on claims submitted for Medicare and some Medicaid patients. - ANS-
DMEPOS
Because HCPCS level II is not a reimbursement methodology or system, its procedure,
product, and service codes _____ coverage/payment. - ANS-do not guarantee
HCPCS level II codes are developed and maintained by _____ and do not carry the
copyright of a private organization, which means they are in the public domain and
many publishers print annual coding manuals. - ANS-CMS (centers for medicaid and
medicare services)
(chapter 8 & 11) Exam
HCPCS codes - ANS-generally for products, supplies, and services, things like
ambulance services, durable medical equipment, prosthetics, and orthotics that aren't
represented by CPT codes; ensure uniform reporting of medical products or services on
claims
excludes1 - ANS-not coded here
excludes2 - ANS-Not included here
modifiers are appended to CPT codes in order to: - ANS-clarify the procedure or service
to go directly to the table of neoplasms, you must know ___ and the ___ of the
neoplasm. - ANS-classification, site
reporting lesion excision requires: - ANS-knowing the size including the margins or the
lesion, and knowing whether the lesion is benign or malignant
What are the key components of E/M? - ANS-1. History
-Chief complaint
-History of Present illness
-Review of Symptoms
-Past, Family and Social History
2. Physical Exam
3.Medical Decision Making Complexity
in what section of CPT are lesion removal codes found? - ANS-surgery
HCPCS level II codes are also known as: - ANS-permanent national codes
when there is a CPT code and a HCPCS level II code available to report a service,
which code should be reported? - ANS-depends on payer policy
miscellaneous codes - ANS-national codes used when a supplier is submitting a bill for
an item or service where no existing national code exists to describe the item or service
being billed
transitional pass-through payments - ANS-temporary additional payments (above the
OPPS reimbursement rate) made for certain innovative medical devices, drugs, and
biologicals provided to Medicare beneficiaries.
, temporary codes - ANS-maintained by the CMS and other members of the HCPCS
National Panel; independent of permanent national codes; allow payers the flexibility to
establish these codes as needed before the next January 1 annual update
The specific HCPCS Level II code determines whether a specific claim is sent to the
MAC that processes provider claims or the ___ ___that processes DMEPOS dealer
claims. - ANS-DME MAC
Annual lists of valid HCPCS Level II codes are obtained by providers and DMEPOS
dealers. They include ______ instructions for services as well. - ANS-billing
CMS decided to have all DME claims processed by one of four DME MACs to reduce
_________ claims. - ANS-fraudulent; DME MACs specialize in the development of
coding guidelines and verification of appropriate coding for these services.
Two claims are generated when a physician treats a Medicare patient for a fractured
femur and supplies the patient with crutches. The physician's claim for the fracture
treatment is sent to the MAC, and the claim for the supply of crutches is sent to the
_____ _____. - ANS-DME MAC
For certain items or services reported on a claim submitted to the DME MAC, the
DMEPOS dealer must receive a signed _____________. - ANS-certificate of medical
necessity (CMN)
HCPCS level II was introduced in 1983 after Medicare found that its payers used more
than 100 different coding systems, making it _____. - ANS-difficult to analyze claims
data
HCPCS furnishes health care providers and suppliers with a _____ language for
reporting professional services, procedures, supplies, and equipment. - ANS-
standardized
Although the majority of procedures and services are reported using CPT (HCPCS level
I), that coding system does not describe _____ (services) and certain other services
reported on claims submitted for Medicare and some Medicaid patients. - ANS-
DMEPOS
Because HCPCS level II is not a reimbursement methodology or system, its procedure,
product, and service codes _____ coverage/payment. - ANS-do not guarantee
HCPCS level II codes are developed and maintained by _____ and do not carry the
copyright of a private organization, which means they are in the public domain and
many publishers print annual coding manuals. - ANS-CMS (centers for medicaid and
medicare services)
