3.2

Question 1

Procedure codes with a status indicator of C indicate the services are ________ under OPPS

Answer 1

Inpatient only procedures. The services are not paid under OPPS.

Question 2

Under the APC system, the reimbursement for the emergency department is based on reporting what type(s) of CPT code(s)?

Answer 2

Using the evaluation and management services based on location of service. Emergency department visit codes are 99281–99285 and G0380 – G0384.

Question 3

Pass – through payments are established for what purpose?

Answer 3

Allow payment for certain drugs, biologicals, and certain devices.

Question 4

Define a significant procedure.

Answer 4

Procedures, therapies or services that are normally scheduled, constitute the reason for the visit, and dominate time and resources expended during the visit.

Question 5

Emergency department codes for facilities are determined by

A. procedures performed by the position during the ED encounter
B. Criteria established by the hospital to determine the E/M facility levels
C. Documentation guidelines published in CMS hospital manual
D. Documentation requirements determined by DHHS

Answer 5

B. Criteria established by the hospital to determine E/M facility levels

Question 6

A level five outpatient clinic visit is reported by the facility with:

A. 99205
B. 99285
C. G0463
D. G0384

Answer 6

C. G0463

Question 7

If the physician expects the patient to remain in the hospital for 24 hours or more:
A. The physician should admit the patient to observation
B. The physician should admit the patient as an impatient.
C. The physician should keep the patient in observation for eight hours and admit the patient after the time period.
D. The physician should admit the patient for the time limit for observation

Answer 7

B. The physician should admit the patient as an inpatient

Question 8

Complete the sentence: a procedure code assigned a status indicator T…

A. is not paid under OPPS, but paid under a fee schedule.
B. Is not paid under OPPS, but paid as a separate cost base pass – through payment
C. Is a significant procedure and separately payable.
D. Is a significant procedure and the multiple reduction applies

Answer 8

D. Is a significant procedure and the multiple reduction applies

Question 9

Which of the following statements are true?

A. A patient who is undergoing a same-day surgical procedure may also require observation services if a complication from the procedure requires monitoring beyond the usual 4 to 6 hour period
B. A patient who undergoes a same-day surgical procedure is always admitted to observation overnight.
C. A patient who undergoes a same-day surgical procedure is never admitted to observation overnight
D. A patient who undergoes the same day surgical procedure may require observation overnight based on physicians orders and will be reimbursed separately

Answer 9

A. A patient who is undergoing the same day surgical procedure may also require observation services if a complication from the procedures requires monitoring be on the usual 4 to 6 hour period.

Question 10

Items and or services included in the facility fee or charge include

Answer 10

Nurses and other technical personnel services, use of the ASC facility, drugs, surgical or medical supplies and services, diagnostic or therapeutic items or services, administrative record keeping, and housekeeping items and services, and materials for anesthesia.