Series CPT Flashcards
According to CPT guidelines, radical reaction of bone tumors includes ___?
Simple or intermediate repair
Incision and drainage codes are divided according to ___.
The condition for which it is being performed
What is a CPT special report?
What is a CPT Category I code?
level 1 HCPCS codes
What is a CPT Category II code?
HCPCS codes
What is a CPT unlisted code?
Which organization developed the Current Procedural Terminology code book?
American Medical Association (AMA)
Centers for Medicare and Medicaid Services (CMS) incorporated CPT into what codebook?
HCPCS
HCPCS is divided into which level codes?
Level I and Level II
CPT was developed by which organization?
American Medical Association (AMA); for professional services
What does CPT 4 stand for?
current procedural terminology, fourth addition
What is HCPCS?
Health care common procedure coding system
How many sections are in the CPT?
- Evaluation and management,
True or false? Evaluation and management codes are used to report surgical procedures.
False. Evaluation and management, or E/M codes are reported to describe services, such as office visits, inpatient visits, and observations.
True or false? CPT guidelines, at the beginning of each section, apply to the entire section.
True
True or false? If a CPT subsection has additional guidelines, they will be noted next to the subsection title
True
How is a partial code notated in the CPT?
As an indented code
What is another term for a code that is followed by the complete description of a procedure?
A standalone code
Where are indented codes located in the CPT?
Under the related standalone code
Where are modifiers found in the CPT?
After the code section in Appendix A
True or false? Modifiers change the description of a code.
False. Modifiers add context but do not change any part of the code they are applied to.
Where in the CPT would you refer to for examples of when to use a code?
Appendix C
An indent codes description begins with any information prior to the ___ in the description of the standalone code.
Semicolon
The indented code’s description begins with any information prior to the semicolon in the description of the standalone code, and the information after the semicolon is replaced with the indented code’s description to assign this code
What are next steps if a coder cannot find a code that isn’t referenced often?
That is, if no other category, one or three code exists to describe the procedure, depending on the manual being used, unlisted codes can be found at the end of the subsection, for which they reference, or they may be found with the guidelines at the beginning of the section
Which codes are used for performance measures?
Category II codes
Which codes are used as part of a program called Quality Payment Program?
Category II Codes
True or false? Category II codes are optional but physicians billing Medicare are rewarded with a bonus for reporting these codes.
True. This is considered a Merit-based Incentive Payment System
What are all category III codes?
Temporary codes (up to five years)
Which codes represent new technology, services, and procedures
Category III codes
True or false? An unlisted code is the last option for a code
True
When is a special report required?
When unlisted or Category III codes are reported
What should a special report include?
A description of the nature, extent, and need for procedure or service.
Also included: time, effort, and equipment necessary
Who requires a special report with the use of unlisted codes?
Third-party payers
True or false? Nature is one of the six elements that a special report must contain.
True
Which punctuation mark between codes in the index of the CPT manual indicates a range of codes is available?
Hyphen
The words that follow a code number in the CPT manual are called:
A code that has all the words that describe the code following it is called what type of code?
Stand alone
Procedures that are experimental, newly approved, or seldom used or reported with what type of code?
Unlisted
What is the order of CPT division from largest to smallest division?
Section, subsection, subheading, category
Which term reflects the technological advances made in medicine that are incorporated into the CPT manual?
Revisions
The words that follow a code number in the CPT manual are called:
procedure/service descriptor
A list of unlisted procedures for use in a specific section of the CPT manual is contained in:
Guidelines
In which CPT appendix would additions, deletions, and revisions be found?
Appendix B
Which entity developed HCPCS in 1978?
Centers for Medicare and Medicaid Services
HCPCS is divided into which codes?
Level I and Level II
CPT codes are considered ___ codes.
Level I HCPCS
Which codes represent equipment, supplies and other healthcare services not represented by CPT?
Level II HCPCS
Which codes are used to report ambulance, durable medical equipment, or DME and supplies, prosthetics and orthotics, chemotherapy and other drugs, hearing and vision care, and various other items and services?
HCPCS codes
Which HCPCS codes begin with letter D?
Dental
Which HCPCS codes begin with letter P
Laboratory services
Which HCPCS codes begin with letter V?
Vision and hearing
Which HCPCS codes begin with letters G, K, Q, S, and T?
Temporary codes
How are temporary codes used?
The remain active until a definitive decision can be made and the temporary code becomes permanent or is deleted
Which temporary codes are used for professional services when a CPT has not yet been established?
G codes
Which temporary codes are for new durable medical equipment?
K codes
Which temporary codes are used when there is not a CPT code to identify drugs and other types of medical equipment or services
(No CPT code exists)
Q codes
Which temporary codes are used for Blue Cross Blue Shield and not Medicare and Medicaid
S codes
Which temporary codes are used by state Medicaid agencies?
T codes
How often is HCPCS updated?
Annually
True or false? HCPCS includes NOS codes.
True
True or false? Only one modifier can be added to a HCPCS code.
False
True or false? DME is used for Medicare and Medicaid.
True
Medicare is for which patients?
Citizens, 65 and older, and those with permanent disability
Medicaid is for which patients?
Those who qualify for financial hardship
How are Medicare claims for DME and related supplies validated?
•Must meet Medicare’s definition of DME and a medical necessity
•Must be determined through documentation or CMN (certificate of medical necessity)
When and how often does CMS (centers for Medicare and Medicaid services.) produce its national PFS (physician fee schedule)?
Fall. Annually. (Called Final Rule)
Where are HCPCS and CPT codes and doller amount approved for each service found?
CMS’ National Physician Fee Schedule
(Also indicates covered and non-covered services.)
True or false? CMS publishes its proposed and final rules in the federal register.
True
True or false? The federal register is published daily.
True
