Chapter 6: HCPCS

Question 1

Which level 3 coding system was created by CMS to report supplies, materials, and injections in 1983?

Answer 1

HCPCS

Question 2

Which HCPCS Codes are temporary procedure/professional services that would otherwise be coded in the CPT book but there isn’t a code for it?

Answer 2

G codes

Question 3

Which HCPSC table is designed to easily direct the coder to drug names and their corresponding codes based on alphabetic list of drugs with cross-references to generic and commercial names?

Answer 3

Table of Drugs
Codes C, J, K, Q, & S

Question 4

Where are the national coverage policy summaries published?

Answer 4

Dept. of HHS portion of the Federal Register under CMS regulations

Question 5

What is the Medicare Exclusion Database (MED)?

Answer 5

An electronic database that contains the CMS Internet Only Manual (IOM) and references to the NCDs.

Question 6

When does CMS update the HCPCS codes?

Answer 6

Updated continuously

Question 7

What is the abbreviation for intra-arterial method of administration?

Answer 7

IA: within artery

Question 8

What is the abbreviation for Intravenous method of administration?

Answer 8

IV: into the vein

Question 9

What is the abbreviation for Intramuscular method of administration?

Answer 9

IM: into the muscle

Question 10

What is the abbreviation for Intrathecal method of administration?

Answer 10

IT: into the subdural space of the spinal cord

Question 11

What is the abbreviation for Subcutaneous method of administration?

Answer 11

SC: via injection just under the skin
**Think TB/PPD test

Question 12

What is the abbreviation for administration by inhaled solution?

Answer 12

INH: breathing it in

Question 13

What is the abbreviation that identifies various routes of administration?

Answer 13

OTH: other administration methods.
(suppositories or catheter inj.)

Question 14

What is the abbreviation that identifies oral administration?

Answer 14

ORAL: taken by mouth

Question 15

What HCPCS codes are not reported by Medicare?

Answer 15

S Codes
used by Private payers and Medicaid

Question 16

Representatives from BCBSA, HIAA, and CMS maintain what?

Answer 16

the national permanent HCPCS Level II codes
- makes additions, revisions, and deletions

Question 17

Who announces the HCPCS updates and when are they released?

Answer 17

CMS announces the release of quarterly updates

Question 18

When using the HCPCS, when is it appropriate to use miscellaneous NOC national codes?

Answer 18

used when no existing national codes describes the item or service being billed.
* these claims are reviewed manually

Question 19

Which HCPCS codes are updated quarterly to allow insurers to establish codes before the next January 1 annual update for permanent national codes?

Answer 19

Temporary National Codes

Question 20

What are the 7 types of temporary HCPCS codes?

Answer 20

1. C
2. G
3. Some H Codes
4. K
5. Q
6. S
7. T

Question 21

Which HCPCS codes are used to describe both emergency and non emergency transportation services, commonly used supplies, and miscellaneous category that included non prescription drugs and radiopharmaceutical diagnostic imaging agents?

Answer 21

A Codes

Question 22

Which codes are used to describe internal and parenteral therapy?

Answer 22

B codes
- type of formula
- supplies necessary to administer

Question 23

Which codes describe services, drugs and supplies reported in the outpatient hospital settings?

Answer 23

C Codes -CMS Hospital OPPS
** always billed on a UB-04 form

Question 24

What are HCPCS D Codes used for?

Answer 24

Dental Procedures

Question 25

In the HCPCS Book, E Codes are used to describe what DME?

Answer 25

Canes, crutches, commodes, decubitus care equipment, bath and toilet aids, hospital beds and accessories, monitor equipment, and wheel chairs

Question 26

DME is covered under Part B as a medical or other health service of the Social Security Act and is equipment that______

Answer 26

1. can withstand repeated use 2. primarily and customarily used to serve a medical purpose 3. generally not useful to a person in the absence of an injury or illness 4. appropriate for use in the home

Question 27

What modifier should be used to document on the claim form that an ABN is completed and signed by the Medicare beneficiary?

Answer 27

GA

Question 28

Which codes are used by Medicaid to identify mental health services including alcohol and drug abuse treatments, as well as prenatal care?

Answer 28

H Codes

Question 29

What do J Codes include?

Answer 29

- injectable or inhaled solution drugs. - chemotherapy and immunosuppressive drugs - usually not self administered

Question 30

Which K codes are temporary codes used by the DME MACs to identify what?

Answer 30

Primarily for wheelchairs and wheelchair accessories

Question 31

L codes are used to report orthopedic and prosthetic procedures and devices. How are these codes categorized?

Answer 31

By body area

Question 32

P codes are used to report Pathology and Laboratory services and is divided into what 4 sections?

Answer 32

1. chemistry & toxicology 2. pathology screening tests 3. microbiology 4. miscellaneous pathology

Question 33

Q does are temporary miscellaneous service codes for supplies, procedures and services that include?

Answer 33

Contrast material screening pap smears chemotherapy administration lab tests pharmacy dispensing fees

Question 34

What are R Codes used for?

Answer 34

to describe the transportation & set up of portable equipment from a facility to a home or nursing home. cannot be billed with an e/m code same DOS

Question 35

which codes were developed by the BCBSA and HIAA to report drugs, supplies, and services for which there are no national codes?

Answer 35

S Codes * used by Medicaid * not reported by Medicare

Question 36

Which codes are national codes established and used by Medicaid to represent HH, Substance abuse treatment, and training-related procedures?

Answer 36

T Codes

Question 37

Which codes are used to describe vision, hearing, and limited speech pathology services?

Answer 37

V Codes