CH6-HCPCS Level II Concepts

Question 1

When 8 mg of Dilaudid® are given intravenously, how many units are reported?

Answer 1

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.

Question 2

Select the supply code for an insertion tray that has a two way all silicone Foley catheter with a drainage bag?

Answer 2

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.

Question 3

A female patient is getting a right and left breast mastectomy bra with integrated form breast prosthesis. What HCPCS Level II code is reported?

Answer 3

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.

Question 4

What are C codes used for in the HCPCS Level II codebook?

Answer 4

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.

Question 5

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?

Answer 5

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).

Question 6

What codes are NOT reported by Medicare?

Answer 6

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).

Question 7

What abbreviation is used for a drug or biological given into the subdural space of the spinal cord?

Answer 7

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.

Question 8

What is the correct code and units to report for 80 mg of Depo-Medrol given IM?

Answer 8

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.

Question 9

An audiologist provided a battery for a hearing device to a patient. What HCPCS Level II code is reported for the battery?

Answer 9

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.

Question 10

What HCPCS Level II code and unit(s) is reported for 4 boxes of alcohol wipes?

Answer 10

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.

Question 11

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

Answer 11

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.

Question 12

What is the route of administration for the drug Vancomycin HCL?
a. IV, IM
b. IV
c. INH
d. SC, IM

Answer 12

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.

Question 13

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

Answer 13

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.”

Question 14

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

Answer 14

G0439
Response Feedback:
The patient is receiving an Annual wellness visit, subsequent. The scenario does not indicate that this is the initial visit.

Question 15

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

Answer 15

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.

Question 16

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

Answer 16

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.

Question 17

What is the correct place of service code of an emergency room encounter?
a. 23
b. 22
c. 11
d. 21

Answer 17

23
Response Feedback:
The place of service code for Emergency room is 23.

Question 18

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

Answer 18

41
Response Feedback:
The place of service code for Ambulance – Land is 41.

Question 19

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

Answer 19

GA
Response Feedback:
GA indicates that an ABN is on file and allows the provider to bill the patient if Medicare denies the claim.

Question 20

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

Answer 20

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.

Question 21

What is the HCPCS Level II code for inpatient hospital hospice care?
a. Q5006
b. Q5008
c. Q5010
d. Q5005

Answer 21

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.

Question 22

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

Answer 22

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.

Question 23

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

Answer 23

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.

Question 24

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

Answer 24

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.

Question 25

What is the HCPCS Level II code for PSA screening?
a. G0102
b.G0103
c. G0104
d. G0105

Answer 25

G0103
Response Feedback:
Rationale: Look in the HCPCS Level II Alphabetic Index for Screening/Cancer/Prostate, rectal, digital exam/PSA (prostate specific antigen) test; which directs you to code G0103. Cross reference to the Tabular List for complete detailed description. The correct code is G0103.

Question 26

Patient weighing 500 pounds is receiving a captain’s chair, group 2 very heavy duty powered wheelchair. What HCPCS Level II code is billed?
a. K0853
b. K0839
c. K0837
d. K0827

Answer 26

K0827
Response Feedback:
Rationale: Look in the HCPCS Level II Alphabetic Index for Wheelchair/Power Operated, which directs you to codes E1230, E1239, K0813-K0899. Cross reference to the Tabular List for complete detailed description. The choice of code is based on the weight of the patient, the type of chair, and the accessories attached. The correct code is K0827 for the captain’s chair for a patient between 451 to 600 pounds. K0839 has no mention a captain’s chair. K0837 is for reporting only heavy duty, 301-450 pounds, with no mention of a captain’s chair. K0853 is reported for group 3, not group 2.

Question 27

What is the HCPCS Level II code for Lidocaine, 10mg?
a. J2010
b. C9285
c. J2001
d. J2020

Answer 27

J2001
Response Feedback:
Rationale: Look in the HCPCS Level II Table of Drugs and Biologicals look for Lidocaine HCL which directs you to code J2001. Cross reference to the Tabular List to confirm complete detailed description. The selection of the code is based on the administration method and dosage units. The correct code is J2001, one unit of 10mg.

Question 28

What is the HCPCS Level II code for a vinyl urinary drainage bag?
a. A5112
b. A4358
c. A5105
d. A4357

Answer 28

A4358
Response Feedback:
Rationale: Look in the HCPCS Level II Alphabetic Index for Bag/Urinary, vinyl which directs you to A4358. Cross reference to the Tabular List for complete detailed description. The code is dependent on the type of bag. The correct code is A4358.

Question 29

What is the HCPCS Level II code for Lupron Depot 3.75 mg?
a. J1950
b. J9219
c. J9218
d. J9217

Answer 29

J1950
Response Feedback:
Rationale: Look in the Table of Drugs and Biologicals for Lupron Depot which directs you to codes J1950 and J9217. Cross reference to the Tabular List to see complete detailed description. The choice of code is based on the administration method and the drug unit dosage. The correct code is J1950 for 3.75 mg.

Question 30

What is the HCPCS Level II code for immune globulin HepaGam B, 0.5ml, IV?
a. J1573
b. J1557
c. J1571
d. J1557 x50

Answer 30

J1573
Response Feedback:
Rationale: Look in the HCPCS Level II Table of Drugs and Biologicals for Immune Globulin Hepagam B. There are two listings; one is for IM and the other is for IV. In this case it states IV, which directs you to code J1573. Cross reference to the Tabular List to confirm complete detailed description. The selection of the code is based on the administration method and dosage units. The correct code is J1573, one unit 0.5ml.

Question 31

What is the HCPCS Level II code for adult’s long arm splint, fiberglass?
a. Q4018
b. Q4019
c. Q4020
d. Q4017

Answer 31

Q4018
Response Feedback:
Rationale: Look in the HCPCS Level II Alphabetic Index for Cast/Long arm splint/Adult, fiberglass which directs you to Q4018. Cross reference to the Tabular List to confirm the complete detailed description. The choice is based on the cast material, the length of splint, body site, and age of patient. The correct code is Q4018.

Question 32

What is the HCPCS Level II code for Ativan, 2mg?
a. J3360
b. J0515
c. J2060
d. S0136

Answer 32

J2060
Response Feedback:
Rationale: Look in the HCPCS Level II Table of Drugs for Ativan, which directs you to see lorazepam. The lorazepam entry directs you to J2060. Cross reference to the Tabular List to confirm complete detailed description. The correct code is J2060.

Question 32

What is the HCPCS Level II code for a bathtub chair?
a. E0247
b. E0240
c. E0163
d. E0160

Answer 32

E0240
Response Feedback:
Rationale: Look in the HCPCS Level II Alphabetic Index for Chair/Bath/Shower which directs you to E0240. Cross reference to the Tabular List for complete detailed description. The correct code is E0240.

Question 33

The physician writes an order for 35 mm/Hg thigh high compression stockings. Which HCPCS Level II code is correct for this item?
a. A6537
b. A6540
c. A6534
d. A6531

Answer 33

A6534
Response Feedback:
Rationale: Look in the HCPCS Level II Alphabetic Index for Compression/Garments and stockings, which directs you to codes A6501-A6550 and K1025. Cross reference to the Tabular List for complete detailed description. The code choice is based on the weave (mm/HG) and the length of the stocking. The correct code is A6534 for 35 mm/Hg of thigh length.

Question 34

Which set of HCPCS Level II codes are covered by Medicaid and not accepted by Medicare?
a. G codes
b. S codes
c. L codes
d. T codes

Answer 34

T codes
Response Feedback:
Rationale: In the beginning of the T codes section (T1000-T9999), the HCPCS Level II book indicates that T codes are designed for use by Medicaid state agencies and are not accepted by Medicare.

Question 36

A 15-year-old female sustained a Colles’ fracture in which the pediatrician performs an application of short arm plaster cast. Identify the HCPCS Level II code that is billed.
a. Q4009
b. Q4011
c. Q4017
d. Q4021

Answer 36

Q4009
Response Feedback:
Rationale: Look in the HCPCS Level II Alphabetic Index for Cast/Supplies/Short arm/Adult, plaster, which directs you to Q4009. Cross reference to the Tabular List for complete detailed description. The code choice is based on age of patient, type of material, and length of cast. If you looked up pediatric and verified Q4011 you would note the age is 0-10 years in the description. The correct code is Q4009 based on the patient being 15 years old.

Question 36

What is the HCPCS Level II code for high top orthotic shoe for an infant?
a. L3201
b. L3204
c. L3207
d. L3206

Answer 36

L3204
Response Feedback:
Rationale: look in the HCPCS Level II Alphabetic Index for Shoes/Orthopedic/High-top/Infant; which directs you to code L3204. The code choice is based on age of patient and style of shoe. The correct code is L3204.

Question 37

What is the HCPCS Level II code for surgical tray?
a. A4649
b. A4550
c. A44490
d. A4320

Answer 37

A4550
Response Feedback:
Rationale: Look in the HCPCS Level II Alphabetic Index for Surgical/Tray or Tray/Surgical; both will direct you to A4550. Cross reference to the Tabular List for complete detailed descriptions. The correct code is A4550.

Question 38

What is the HCPCS Level II code for cervical traction equipment not requiring additional stand or frame?
a. E0855
b. E0850
c. E0849
d. E0856

Answer 38

E0855
Response Feedback:
Rationale: Look in the HCPCS Level II Alphabetic Index for Cervical/Traction which directs you to codes E0855 and E0856. Cross reference to the Tabular List to confirm complete detailed description. The correct code is E0855.

Question 39

What is the HCPCS Level II code for replacement of a cochlear implant transmitting coil?
a. L8615
b. L8618
c. L8617
d. L8614

Answer 39

L8617
Response Feedback:
Rationale: Look in the HCPCS Level II Alphabetic Index for Cochlear prosthetic implant/Transmitting coil/cable which directs you to codes L8617 and L8618. Cross reference to the Tabular List for complete detailed description. The correct code is L8617.

Question 40

What is the HCPCS Level II code for a large adult size disposable pull-on protective underwear?
a. T4532
b. T4536
c. T4527
d. T4523

Answer 40

T4527
Response Feedback:
Rationale: Look in the HCPCS Level II Alphabetic Index for Diaper/Garment which directs you to codes T4521-T4540, T4543, and T4544. Cross reference to the Tabular List for complete detailed description. The choice of code is based on adult/pediatric as well as the size and type of garment. The correct code is T4527.

Question 41

Which HCPCS Level II codes are billed for ambulance services?
a. C codes
b. A codes
c. B codes
d. D codes

Answer 41

A codes
Response Feedback:
Rationale: When reviewing each section of codes given in the choices, A codes is the correct answer. At the beginning of the A codes, the subheading indicates Transportation Services Including Ambulance (A0021-A0999).

Question 42

What is the HCPCS Level II code for Morphine Sulfate 100 mg, IM?
a. J2274 x10
b. J2270
c. J2274
d. J2270 x10

Answer 42

J2270 x10
Response Feedback:
Rationale: Look in the Table of Drugs and Biologicals for Morphine Sulfate, which directs you to codes J2270 and J2274. Cross reference to the Tabular List for complete detailed description. The choice of code is based on whether the morphine sulfate is preservative-free and being used for epidural, or intrathecal, which is not documented in this case. In this case 100 mg was administered. The correct code is J2770 x 10 to show that 100 mg was administered.