Chapter 6

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

a. A codes On the first page of each HCPCS Level II Tabular List section is a subheading describing the type of services found and the code range. The correct answer is A codes, which are defined in the subheading as Transportation Services Including Ambulance (A0021-A0999).

What is the HCPCS Level II code for nonemergency taxi transportation? a. A0100 b. A0080 c. A0090 d. A0021

a. A0100 Look in the HCPCS Level II Alphabetic Index for Taxi, nonemergency transportation or Transportation/Nonemergency/Taxi; both will direct you to A0100. Cross reference to the Tabular List for complete detailed descriptions. The correct code is A0100.

What HCPCS Level II code and unit(s) is reported for 4 boxes of alcohol wipes? a. A4245 x 4 b. A4245 x 1 c. A4244 x 1 d. A4244 x 4

a. A4245 x 4 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.

Select the supply code for an insertion tray that has a two way all silicone Foley catheter with a drainage bag? a. A4312 b. A4314 c. A4315 d. A4311

c. A4315 Look in the HCPCS Level II Index for Foley catheter. It 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.

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

b. G0103 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.

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

b. IV, IM Look in the HCPCS Level II Table of Drugs and Biologicals for Vancomycin HCL. The routes of administration are IV and IM.

Bilateral removable foot inserts are molded directly to a patient's longitudinal arch model for use in athletic shoes. This is to alleviate the patient's back pain associated with collapsed arches. What is the code that reports the orthotic device? a. L3030 x 2 b. L3010 x 2 c. L3020 x 2 d. L3040 x 2

b. L3010 x 2 Look in the HCPCS Level II Alphabetic Index for Shoes/Insert, removable/Longitudinal arch support, each; which directs you to code L3010. Cross reference to the Tabular List for complete detailed description. In this case, bilateral (two) inserts were molded. The correct code is L3010 x 2 to report that 2 were made for the patient.

What is the HCPCS Level II code for speech screening? a. V5363 b. V5362 c. S9128 d. S9152

b. V5362 Look in the HCPCS Level II Alphabetic Index for Screening/Speech which directs you to V5362. Cross reference to the Tabular List to confirm complete detailed description. The correct code is V5362.

What is the HCPCS Level II code for parenteral nutrition, premix kit per day? a. B4222 b. B4224 c. B4220 d. B4185

c. B4220 Look in the HCPCS Level II Alphabetic Index for Parenteral nutrition/Supply kit/Premix per day which directs you to code B4220. Cross reference to the Tabular List for complete detailed description.The correct code is B4220.

A stationary toilet chair with fixed arms is ordered for a patient who is confined to a bed. What is the code for this DME? a. E0171 b. E0165 c. E0163 d. E0170

c. E0163 Look in the HCPCS Level II Alphabetic Index for Commode/Chair, mobile or stationary; which directs you to codes E0163-E0165. Cross reference the Tabular List for complete detailed description. The code choice is based on the type of chair and accessories included. The correct code is E0163.

What is the HCPCS Level II code for air pressure mattress? a. E0196 b. E0197 c. E0186 d. E0199

c. E0186 Look in the HCPCS Level II Alphabetic Index for Mattress/air pressure which directs you to code E0186. Cross reference to the Tabular List for complete detailed description. The correct code is E0186.

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. EE d. ED

c. 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 45-year-old diabetic female received the following diabetic supplies:6 boxes of alcohol wipes4 boxes of lancets (100 per box)15 boxes of glucose test strips (50 per box) What HCPCS Level II codes are reported? a. A4245 x 6, A4259 x 4, A4253 x 15 b. A4245, A4259, A4253 c. A4247 x 6, A4258 x 400, A4255 x 50 d. A4245 x 6, A4259 x 4, A4255 x 15

a. A4245 x 6, A4259 x 4, A4253 x 15 The correct codes are A4245 x 6, A4259 x 4, A4253 x 15.Look in the HCPCS Level II Alphabetic Index for each of the listed supply items as follows:Alcohol (and drug)/Wipes; which directs you to code A4245. Cross reference to the Tabular list for each code to get the complete detailed description. The patient received six boxes. The correct code is A4245 x 6 to report the six boxes.Lancet spring-powered device/Per box; which directs you to code A4259. Cross reference to the Tabular list for each code to get the complete detailed description. The patient received four boxes. The correct code is A4529 x 4 to report the four boxes.Strip/Blood glucose test; which directs you to codes A4253 and A4772. Cross reference to the Tabular list for each code to get the complete detailed description. The patient received 15 boxes. There is no mention of dialysis. The correct code is A4253 x 15 to report the 15 boxes.

What is the HCPCS Level II code for a folding walker, wheeled, adjustable or fixed height? a. E0143 b. E0144 c. E0141 d. E0148

a. E0143 Look in the HCPCS Level II Alphabetic Index for Walker which directs you to codes E0130-E0149 or Folding/Walker which directs you to codes E0135 and E0143. Cross reference to the Tabular List for complete detailed description. The choice is based on the accessories included with the walker. The correct code is E0143.

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. G0438 c. 99397 d. 99387

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

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. GZ c. GY d. GX

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

A patient receives Remicade via a 45-minute infusion. What is the correct CPT/HCPCS Level II combination? a. J1745, 96365 b. J1745, 96413 c. J1750, 96401 d. J1750, 96372

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.

What is the HCPCS Level II code for the compounded concentrated form of 0.5 mg Levalbuterol HCL when inhaled? a. J7607 b. J7612 c. J7614 d. J7615

a. J7607 Look in the Table of Drugs and Biologicals for Levalbuterol HCL, concentrated form; which directs you to codes J7607 and J7612. Cross reference to the Tabular List for complete detailed description. The choice of code is based on the administration method, product form, and drug unit designation. The correct code is J7607 for inhaled, compound of 0.5 mg.

A female patient is getting a right and left breast mastectomy bra with integrated form breast prosthesis. What HCPCS Level II code is reported? a. L8002 b. L8002-50 c. L8001-50 d. L8000

a. L8002 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.

What is the HCPCS Level II code for transportation of portable EKG to facility or location, per patient? a. R0076 b. R0075 c. R0070 d. C892

a. R0076 Look in the HCPCS Level II Alphabetic Index for Transportation/EKG equipment, portable which directs you to R0076. Cross reference to the Tabular List to confirm the complete detailed description. The correct code is R0076.

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

a. T4527 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.

When 8 mg of Dilaudid® are given intravenously, how many units are reported? a. 1 b. 2 c. 3 d. 4

b. 2 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.

What is the HCPCS Level II code for an infusion pump which delivers soy-based 100 calories/unit pediatric enteral nutrition? a. B9006 b. B9002 c. K0455 d. C262

b. B9002 Look in the HCPCS Level II Alphabetic Index for Pump/Enteral infusion; which directs you to code B9002. Cross reference to the Tabular List for complete detailed description. The correct code is B9002.

If a procedure is performed on a 72 year-old Medicare patient, which code category is preferred for reporting? a. S code in the HCPCS Level II b. G code in the HCPCS Level II c. CPT® code d. A HCPCS Level II code and CPT® code

b. G code in the HCPCS Level II If a code exists in the HCPCS Level II codebook for a procedure and it was performed on a Medicare patient, the HCPCS Level II "G" code is used over a CPT® code. S codes are used by BCBS.

What is the HCPCS Level II code for administration of Hepatitis B vaccine? a. G0008 b. G0010 c. G0009 d. 96372

b. G0010 Look in the HCPCS Level II Alphabetic Index for Administration/vaccine/Hepatitis B, which directs you to G0010. Cross reference to the Tabular List for complete detailed description. The correct code is G0010.

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. G0438 b. 99387 c. G0402 d. 99397

c. 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 abbreviation is used for a drug or biological given into the subdural space of the spinal cord? a. IV b. IM c. IT d. SC

c. IT IT is an abbreviation for intrathecal, for an administration of the drug is given into the subdural space of the spinal cord.

A patient receives Rituxan via a 3 hour, 15-minute infusion. What is the correct CPT/HCPCS Level II combination? a. J9312, 96365 x 4 b. J9315, 96413, 96415 X 3 c. J9312, 96413, 96415 X 2 d. J9315, 96365, 96366 X2

c. 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 HCPCS Level II code for complete assembly footrest replacement for a wheelchair billed to a DME MAC? a. K0043 b. K0044 c. K0045 d. K0046

c. K0045 Look in the HCPCS Level II Alphabetic Index for Footrest/Complete assembly, replacement; which directs you to K0045. Cross reference to the Tabular List for complete detailed description. The choice of code is based on the insurance being billed, and the accessory parts included. The correct code is K0045 for billing to a DME MAC for Medicare.

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

c. Q4018 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.

Mr. Brown is seeing his ENT physician to receive a monaural digitally programmable analog hearing aide in his right ear. What HCPCS Level II code is billed? a. V5256 b. V5243 c. V5246 d. V5252

c. V5246 The following acronyms are used pertaining to audiology services; BTE (behind the ear), CIC (completely in canal), ITC (in the canal), and ITE (in the ear). Look in the HCPCS Level II Alphabetic Index for Hearing aid/Monaural/Digitally programmable/ITE which directs you to V5246. Cross reference to the Tabular List for complete detailed description. The correct code is V5246.

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

d. 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. 23 b. 21 c. 42 d. 41

d. 41 The place of service code for Ambulance - Land is 41.

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

d. A4358 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.

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

d. A6534 Look in the HCPCS Level II Alphabetic Index for Compression stockings which directs you to codes A6530-A6549. 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.

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. E0292 b. E0296 c. E0290 d. E0294

d. E0294 Look in the HCPCS Level II Alphabetic Index for Bed/Hospital/Semi-electric/With mattress; which directs you to codes E0260 and E0294. 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. The correct code is E0294 for without handrails.

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

d. E0855 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.

A Medicare patient receives a routine screening flexible sigmoidoscopy for cancer screening . What is the correct CPT or HCPCS Level II code? a. G0106 b. G0105 c. 45330 d. G0104

d. 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

What is the correct code and units to report for 80 mg of Depo-Medrol given IM? a. J1020 x 1 b. J1020 x 4 c. J1030 x 2 d. J1040 x 1

d. J1040 x 1 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.

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

d. J2060 Look in the HCPCS Level II Table of Drugs and Biologicals for Ativan which directs you to code J2060. An additional listing directs you to See Also Lorazepam. Cross reference to the Tabular List to confirm complete detailed description. The correct code is J2060, 2mg.

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? a. J8610 x 6 b. J9260 c. J9250 x 5 d. J9250 x 3

d. J9250 x 3 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).

What are C codes used for in the HCPCS Level II codebook? a. Reporting ambulance services b. Reporting durable equipment c. Reporting procedures for professional services d. Reporting outpatient services used by hospitals paid under the ACS and OPPS

d. Reporting outpatient services used by hospitals paid under the ACS and OPPS 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.

What codes are NOT reported by Medicare? a. A codes b. G codes c. J codes d. S codes

d. S codes 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).

Patient is returning to her gynecologist for her annual gynecological exam. She has BCBS for insurance. What HCPCS Level II code is reported? a. G0101 b. S0613 c. S0610 d. S0612

d. S0612 Look in the HCPCS Level II Alphabetic Index for Annual/Gynecological examination/Established patient which directs you to S0612. Cross reference to the Tabular List for complete detailed description. The notation of BCBS for the patient's insurance indicates to use an S code. There is no indication in the question that a breast exam was performed, so S0613 is not billed. The patient is returning to her gynecologist indicating she is an established patient, eliminating S0610. The correct code is S0612.

An audiologist provided a battery for a hearing device to a patient. What HCPCS Level II code is reported for the battery? a. A4601 b. L8622 c. L8624 d. V5266

d. V5266 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.