HCPCS Exam Study Guide

HCPCS Exam Study Guide CPT, HCPCS Level II and HCPCS Level III codes are all HIPAA-approved National Codes Sets. a.) True b.) False - b: False. HCPCS Level III codes are not included in the HIPAA-approved National Code Sets. They will be eliminated on Dec. 31, 2003. In most cases, which modifier is needed for an emergency room case when reporting both a CPT surgery code and evaluation and management (E/M) code? a.) 52 b.) 59 c.) 25 - c: Modifier -25 is appended to the ED E/M code. Modifier -25 identifies significant, separately identifiable E/M services on the same day of the procedure or other services. In most instances, patients that come to the ED do not present to have a procedure performed. The patient first needs to be evaluated by a physician. HCPCS Level II "A" codes represent: a.)Transportation services, including ambulance b.)Durable medical equipment c.)Temporary medical and surgical supplies - a: HCPCS Level II A codes are used to report transportation services, including ambulance. CPT codes and HCPCS Level II codes are updated by CMS annually. a.) True b.) False - b: False. HCPCS Level II codes are updated by CMS. CPT codes are not. CPT codes are updated by AMA. A flexible diagnostic colonoscopy is performed. During the procedure, a polyp is removed from one area and a lesion is removed from another. Both the polyp and the lesion are removed by snare technique. Which of the following would be the appropriate code selection? a) 45378-59, 45385, 45385-59 b) 45385, 45385-59 c) 45385 d) 45378-59, 45385 - c: Only code 45385 is reported. The diagnostic colonoscopy is not coded separately. Notice the separate procedure designation. The diagnostic colonoscopy is included in the code for any definitive procedure performed. 45385 is not reported twice because the description of the code indicates "with removal of tumor(s), polyp(s), or other lesion(s) by snare technique." Therefore, all tumors, polyps or lesions removed using this technique are reported only once. The same CCI edits are used by CMS for editing both physician and hospital outpatient services. a) True b) Fals - b: False. The CCI edits used by CMS to edit physician and hospital outpatient services are not the same. CMS uses the most current version of CCI edits to edit physician services. The CCI edits used by CMS to edit hospital outpatient services are included in the Outpatient Code Editor (OCE) and is one release behind. Also, the CCI edits