Chapter 6 Practical Flashcards
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) 99387.
(B) G0402.
(C) G0438.
(D) 99397.
(B) G0402.
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) INH.
(B) SC, IM.
(C) IV, IM.
(D) IV.
(C) IV, IM.
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) EA.
(B) ED.
(C) EB.
(D) EE.
(D) EE.
The patient’s anemia is due to the chronic kidney disease. The HCT level has been less than 39% for 3 consecutive months.
A 72-year old Medicare patient is seen for a subsequent annual wellness visit. What CPT or HCPCS Level II code is reported?
(A) 99387.
(B) G0438.
(C) G0439.
(D) 99397.
(C) G0439.
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) J1745, 96365.
(B) J1750, 96372.
(C) J1745, 96413.
(D) J1750, 96401.
(A) J1745, 96365.
The HCPCS Level II code is J1745. The correct administration code is 96365 because Remicade is not a chemotherapy or other 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, 96413, 96415 X 2.
(B) J9315, 96413, 96415 X 3.
(C) J9312, 96365 x 4.
(D) J9315, 96365, 96366 X 2.
(A) J9312, 96413, 96415 X 2.
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) 21.
(B) 22.
(C) 23.
(D) 11.
(C) 23.
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) 42.
(B) 21.
(C) 23.
(D) 41.
(D) 41.
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) GA.
(B) GX.
(C) GZ.
(D) GY.
(A) GA.
GA indicates that an ABN is on file and allows the provider to bill the patient if Medicare denies the claim.
A Medicare patient receives a routine screening flexible sigmoidoscopy for cancer screening . What is the correct CPT or HCPCS Level II code?
(A) 45330.
(B) G0105.
(C) G0104.
(D) G0106.
(C) G0104.
Because this is a Medicare patient, a HCPCS code is used if available. Look in the HCPCS Index for Sigmoidoscopy, cancer screening and you are directed to G0104, G0106. G0105 is for a high-risk individual and G0106 is for a barium enema, neither of which are mentioned in this scenario.
