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Billing > Chapter 6: HCPCS > Flashcards

Chapter 6: HCPCS Flashcards

1
Q

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

A

HCPCS

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2
Q

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?

A

G codes

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3
Q

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?

A

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

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4
Q

Where are the national coverage policy summaries published?

A

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

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5
Q

What is the Medicare Exclusion Database (MED)?

A

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

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6
Q

When does CMS update the HCPCS codes?

A

Updated continuously

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7
Q

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

A

IA: within artery

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8
Q

What is the abbreviation for Intravenous method of administration?

A

IV: into the vein

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9
Q

What is the abbreviation for Intramuscular method of administration?

A

IM: into the muscle

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10
Q

What is the abbreviation for Intrathecal method of administration?

A

IT: into the subdural space of the spinal cord

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11
Q

What is the abbreviation for Subcutaneous method of administration?

A

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

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12
Q

What is the abbreviation for administration by inhaled solution?

A

INH: breathing it in

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13
Q

What is the abbreviation that identifies various routes of administration?

A

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

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14
Q

What is the abbreviation that identifies oral administration?

A

ORAL: taken by mouth

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15
Q

What HCPCS codes are not reported by Medicare?

A

S Codes
used by Private payers and Medicaid

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16
Q

Representatives from BCBSA, HIAA, and CMS maintain what?

A

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

17
Q

Who announces the HCPCS updates and when are they released?

A

CMS announces the release of quarterly updates

18
Q

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

A

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

19
Q

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

A

Temporary National Codes

20
Q

What are the 7 types of temporary HCPCS codes?

A
  1. C
  2. G
  3. Some H Codes
  4. K
  5. Q
  6. S
  7. T
21
Q

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?

A

A Codes

22
Q

Which codes are used to describe internal and parenteral therapy?

A

B codes
- type of formula
- supplies necessary to administer

23
Q

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

A

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

24
Q

What are HCPCS D Codes used for?

A

Dental Procedures

25
Q

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

A

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

26
Q

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

A
  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
27
Q

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

A

GA

28
Q

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

A

H Codes

29
Q

What do J Codes include?

A
  • injectable or inhaled solution drugs.
  • chemotherapy and immunosuppressive drugs
  • usually not self administered
30
Q

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

A

Primarily for wheelchairs and wheelchair accessories

31
Q

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

A

By body area

32
Q

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

A
  1. chemistry & toxicology
  2. pathology screening tests
  3. microbiology
  4. miscellaneous pathology
33
Q

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

A

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

34
Q

What are R Codes used for?

A

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

35
Q

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

A

S Codes
* used by Medicaid
* not reported by Medicare

36
Q

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

A

T Codes

37
Q

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

A

V Codes

38
Q
A

Billing (14 decks)

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