CH6-HCPCS Level II Concepts Flashcards
(44 cards)
When 8 mg of Dilaudid® are given intravenously, how many units are reported?
2
Response Feedback:
Look in the Table of Drugs and Biologicals for Dilaudid; it refers you to see Hydromorphone, HCL. Hydromorphone HCL is up to 4 mg given SC, IM or IV and the table refers you to J1170. J1170 is for 4 mg per unit, so 2 units are reported. Verify code selection the tabular section of the HCPCS Level II codebook.
Select the supply code for an insertion tray that has a two way all silicone Foley catheter with a drainage bag?
A4315
Response Feedback:
Look in the HCPCS Level II Index for Foley catheter. This directs you to codes A4312-A4316, A4338-A4346. Review the codes, code A4315 is the correct code because the two-way Foley catheter was all silicone with a drainage bag.
A female patient is getting a right and left breast mastectomy bra with integrated form breast prosthesis. What HCPCS Level II code is reported?
L8002
Response Feedback:
Look in the HCPCS Level II index for Breast prosthesis. It directs you to L8000-L8035, L8600. The correct code for both breasts needing the prosthesis in the bra is L8002. Modifier 50 is not reported on the code because the code description already indicates that the bra is for a bilateral integrated prosthesis.
What are C codes used for in the HCPCS Level II codebook?
Reporting outpatient services used by hospitals paid under the ACS and OPPS
Response Feedback:
At the beginning of the C section, the subheading indicates Outpatient PPS (C1713-C9899). C codes are used on Medicare Ambulatory Surgical Center (ACS) and Hospital Outpatient Prospective Payment System (OPPS) claims.
Patient is given 15 mg of methotrexate sodium IM for rheumatoid arthritis given from 5 mg vials. What HCPCS Level II code and unit(s) is reported?
J9250x3
Response Feedback:
Look in the HCPCS Level II Table of Drugs for Methotrexate Sodium, one of the routes is IM (intramuscular) directing you to code J9250. This drug is reported for 5mg. The patient received 15 mg of methotrexate. The correct way to code this injection is J9250 x 3 (3 x 5 = 15 mg).
What codes are NOT reported by Medicare?
S codes
Response Feedback:
S codes are used by the Blue Cross Blue Shield Associate and the Health Insurance Association of America. They are also used by the Medicaid program but not payable by Medicare. In the beginning of the S codes the heading indicates Temporary National Codes Established by Private Payers (Non-Medicare) (S0000-S9999).
What abbreviation is used for a drug or biological given into the subdural space of the spinal cord?
IT
Response Feedback:
IT is an abbreviation for intrathecal, for an administration of the drug is given into the subdural space of the spinal cord.
What is the correct code and units to report for 80 mg of Depo-Medrol given IM?
J1040x1
Response Feedback:
Look in the Table of Drugs and Biologicals for Depo-Medrol. There are three entries for the amount given. 80 mg given IM is reported with J1040. Because the unit per is 80 mg, only one unit is reported. Verify code selection the tabular section of the HCPCS Level II codebook.
An audiologist provided a battery for a hearing device to a patient. What HCPCS Level II code is reported for the battery?
V5266
Response Feedback:
Look in the HCPCS Level II index for Hearing Devices and you are directed to V5000-V5299, L8614. Review the codes and code V5266 is the correct code to report.
What HCPCS Level II code and unit(s) is reported for 4 boxes of alcohol wipes?
A4245x4
Response Feedback:
Look in the HCPCS Level II index for Alcohol wipes. It directs you to A4245. HCPCS code A4245 is reported per box, so you will need to report 4 units for the 4 boxes of alcohol wipes.
A patient is new to Medicare this year and sees his local family physician for his initial preventive physical for Medicare. What CPT or HCPCS Level II code is reported?
a. 99397
b. 99387
c.G0402
d. G0438
G0402
Response Feedback:
Look in the HCPCS Level II codebook for Physical examination/Preventive G0402. Medicare allows one initial preventive visit during the first 12 months of Medicare. Preventive services allowed by Medicare are often reported with a HCPCS Level II code from the G section.
What is the route of administration for the drug Vancomycin HCL?
a. IV, IM
b. IV
c. INH
d. SC, IM
IV, IM
Response Feedback:
Look in the HCPCS Level II Table of Drugs and Biologicals for Vancomycin HCL. The routes of administration are IV and IM.
An ESRD patient is being treated for anemia and their HCT reading has been 37% for the past 3 months. Which modifier is applied to the ESA?
a. EB
b. EA
c. ED
d. EE
EE
Response Feedback:
The patient’s anemia is due to the chronic kidney disease. The HCT level has been less than 39% for 3 consecutive months. Modifier EE states, “Hematocrit level has not exceeded 39 percent for three or more consecutive billing cycles.”
A 72-year old Medicare patient is seen for a subsequent annual wellness visit. What CPT or HCPCS Level II code is reported?
a. G0439
b. 99397
c. G0438
d. 99387
G0439
Response Feedback:
The patient is receiving an Annual wellness visit, subsequent. The scenario does not indicate that this is the initial visit.
A patient receives Remicade via a 45-minute infusion. What is the correct CPT/HCPCS Level II combination?
a. J1750, 96401
b. J1745, 96415
c. J1745, 96413
d. J1750, 96372
J1745, 96415
Response Feedback:
Rationale: The HCPCS Level II code is J1745. The correct administration code is 96413 because Remicade is a highly complex drug.
A patient receives Rituxan via a 3 hour, 15-minute infusion. What is the correct CPT/HCPCS Level II combination?
a. J9312, 96365x4
b. J9315, 96365, 96366x2
c. J9315, 96413, 96415x3
d. J9312, 96413, 96415x2
J9312, 96413, 96415x2
Response Feedback:
Rituxan is a chemotherapy drug reported with code J9312 . For chemotherapy administration the first hour is coded 96413 and the additional 2 hours is coded 96415 twice. The final 15 minutes is not billable as it was not longer than 30 minutes.
What is the correct place of service code of an emergency room encounter?
a. 23
b. 22
c. 11
d. 21
23
Response Feedback:
The place of service code for Emergency room is 23.
A 6 year-old girl is injured in an automobile accident. She is transported to the emergency room by ambulance. What is the correct place of service for the transport?
a. 21
b. 23
c. 42
d. 41
41
Response Feedback:
The place of service code for Ambulance – Land is 41.
A patient presents for a procedure that Medicare may not pay for due to medical necessity. This is explained to the patient. The patient still wants to have the procedure and agrees to pay in the event that Medicare denies the claim. What modifier should be applied to the procedure to indicate the patient has signed an ABN?
a. GY
b. GA
c. GZ
d. GX
GA
Response Feedback:
GA indicates that an ABN is on file and allows the provider to bill the patient if Medicare denies the claim.
Patient with multiple injuries is being released home for home care. A hospital bed with electronic mattress adjustments for head and feet but without handrails will be in the patient’s home. What is the DME HCPCS Level II code to bill?
a. E0290
b. E0294
c. E0292
d. E0296
E0294
Response Feedback:
Rationale: Look in the HCPCS Level II Alphabetic Index for Bed/Hospital/Semi-electric, which directs you to codes E0261 and E0295. Semi-electric allows for only head and foot adjustments, whereas total electric allows for head, foot, and height adjustments. In this case, there is no mention of height adjustments as an accessory. Cross reference to the Tabular List for complete detailed description. E0295 states without side rails and without mattress. If you look at E2094, it states without side rails and with mattress. The correct code is E0294 for without handrails and with mattress.
What is the HCPCS Level II code for inpatient hospital hospice care?
a. Q5006
b. Q5008
c. Q5010
d. Q5005
Q5005
Response Feedback:
Rationale: Look in the HCPCS Level II Alphabetic Index for Hospice and/or home health services, Inpatient hospital which directs you to Q5005. Cross reference for complete detailed descriptions. The code choice is based on the type of facility. The correct code is Q5005 for inpatient hospital.
A 6-year-old patient is seen in the physician’s office for a penicillin shot to treat strep throat. The patient is given 500,000 units of penicillin G procaine aqueous. How is this service billed?
a. 90471, J0561
b. 96372, J0558
c. 96372, J2510
d. 90460, J2540
96372, J2510
Response Feedback:
Rationale: Look in the CPT® codebook Index for Injection/Intramuscular/Therapeutic which directs you to 96372 and 99506. Cross reference to the numeric section for complete detailed description. The correct administration code is 96372 which directs you to specify substance or drug. Look in HCPCS Level II Table of Drugs and Biologicals for Penicillin G Procaine Aqueous which refers you to J2510. Cross reference to the Tabular List for complete detailed description. The code choice is based on the administration method and the dosage quantity of the medication. In this case 500,000 units were administered. The correct code is J2510 to show that 500,000 units was administered.
A 65-year-old patient is seen in her physician’s office with a laceration on her forehead. The cut is not deep for a suture repair. The physician decides to repair the wound with tissue adhesive. How would this be billed?
a. G0168
b. A4364
c. C1765
d. A4452
G0168
Response Feedback:
Rationale: Look in the HCPCS Level II Alphabetic Index for Adhesive/Tissue (wound closure) which directs you to code G0168. Cross reference to the Tabular List for complete detailed description. The correct code is G0168.
What is the HCPCS Level II code for High osmolar contrast material, 200-249 mg/ml iodine concentration per ml?
a. Q9966
b. Q9960
c. Q9959
d. Q9965
Q9960
Response Feedback:
Rationale: Look in the HCPCS Level II Alphabetic Index for High osmolar contrast material which directs you to codes Q9958-Q9964. Cross reference to the Tabular List for complete detailed description. The code choice is based on iodine concentrate and quantity per mil. The correct code is Q9960 for 200-249 mg/ml.
