CPT/HCPCS Level I coding

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1.) Healthcare Common Procedural Coding System
2.) Level I = CPT codes & Level II = National Codes

1.) HCPCS stands for_______?
2.) It is divided into________?

Level I codes

CPT are incorporated as Level ________codes?

Current Procedural Terminology

CPT stands for_________?

Level II codes

Level ______ codes/National Codes are alphanumeric codes used by providers to report services, supplies, and equipment provided to Medicare and Medicaid patients for which no CPT codes exist.

Level III codes

Level_______ codes were developed by Medicare carriers or state payers to use at the local level but are no longer available since the implimentation of HIPAA although some were integrated into National codes.

Category I

CPT codes are referred to as Category ____codes?

AMA, 1966

The CPT coding system was first developed by the______ in ________ ?

Category II

Ending in F, optional performance measures (e.g. 3014F, Screening Mammography) are _____________codes?

Category III

Ending in T, temporary codes that identify emerging technologies, services, and procedures are _______codes?.

1.) CMS
2.) 1983

The CPT was incorporated as LEVEL I codes into the HCPCS system by the
1.)_________ in 2.)_________?

1.) Sections
2.) Evaluation and management (E & M), Anesthesia, Surgery, Radiology, Pathology and Laboratory, Medicine.

The six main chapters of the CPT manual that describe procedures are referred to as 1.)____________? They include 2.)______(6 items)?

subsections, subheadings, categories, and subcategories.

The sections of the CPT/HPCS Level I is further subdivided by?

1.) Procedure or service
2.) Organ or other anatomic site
3.) Condition
4.) Synonyms, Eponyms, and Abbreviations

The CPT Index contains four primary classes of entries. They are:_______?

False? ICD-9, Volume 3 is used for these inpatient procedures. National codes are used in outpatient settings.

True/False? National Codes are used by health care facilities to report services to inpatients?

Modifiers, (2 digits, 2 letters, letter & number)

____________ provide additional information or "adds to the story" regarding services provided to a patient when the regular five digit CPT code does not completely reflect the service or procedure provided?

1.) Alternative anatomic sites
2.) Alternative procedures
3.) description of the extent of the service

Words following the semicolon in stand-alone codes can indicate one of the following three things?

True

True/False? Symbols with definitions are located at the bottom of the page in the CPT manual.

Bullet

Symbol for new procedure description?

Triangle

Symbol for revised procedure description?

right and left triangle

Symbols that indicate the beginning and end of text changes in a description?

1.) Plus (+) symbol
2.) An add-on code can not be used alone. The code that the add-on is associated with must be sequenced first.

1.) Symbol indicating an add-on code?
2.) How are add-on codes reported?

Null symbol aka. circle with a line through it (think "no smoking" symbol)

Symbol for modifier -51 (indicating multiple procedures) exempt codes?

Bullseye

Symbol for moderate conscious use of sedation is included in procedure?

lightning bolt.

Symbol for product pending FDA approval status?

Pound (#) symbol

Symbol that appears before resequenced codes?

1.) Stand-alone codes
2.) Indented codes
3.) portion of the associated stand-alone code description that precedes the semicolon.

1.) Codes that contain a full description?
2.) Codes that are listed & indented under stand alone codes?
3.) In CPT it is understood that descriptions for indented codes include the____________?

unlisted procedure, only if no Category I CPT or Category III code is available.

A procedure or service not found in the CPT manual can be coded as an _______ procedure only if________?

Special report - used to describe the nature, extent, and need for the procedure or service & the time, effort and equipment necessary to provide the service.

__________ must accompany claims when an unusual, new, seldom used, or Category I unlisted code or Category III code is usubmitted?

CPT guidelines and notes

___________ provide specific information about coding in a given section of the CPT and contain valuable information for the coder. They are found at the beginning of each section and may contain definitions of terms, applicable modifiers, subsection information, unlisted services, special reports information, or clinical examples.

False. Assigning aproximate codes is not appropriate. An exact code must be used.

True/False? If a coder is unable to locate a code that describes the service exactly, isit is appropriate to assign a code that apoximates the service?

True. Destruction can be considered integral.

True/False? According to the surgery guidelines, destruction can be considered part of (integral to) a procedure.

b.) procedure/service descriptor

The words that follow a code number a code in the CPT manual are called_____?
a.) format descriptor
b.) procedure/service descriptor

c.) stand-alone

Acode that has all of the words in the code that follows is ______?
a.) developed
b.) isolated
c.) stand-alone
d.) complete

a.) unlisted/Category III

Experimental, newly approved or seldom used procedures?
a.) unlisted/Category III
b.) technical
c.) modified
d.) variable

b.) third party payers

Who requires a special report with the use of an unlisted code?
a.) AMA
b.) third party payers
c.) CPT manual
d.) National Center for Healthcare

c.) nature, extent, need (Note: the other three things are, time, effort and equipment).

Which three of six items must a special report contain?
a.) condition, service description,
b.) anatomic site, service extent
c.) nature, extent, need
d.) service, extent, procedure

The hyphen.

Which punctuation mark between codes in the index of the CPT manual indicates a range of codes is available?

The coma.

Which punctuation mark between codes in the index of the CPT manual indicates two codes?

The guidelines of each section.

The lists of unlisted procedures, of each section, of the CPT manual are listed in?

Appendix B.

In which CPT Appendix would additions, deletions, and revisions be found?

Appendix A.

In which CPT Appendix would all modifiers be found?

Revisions.

Which terms reflects the technological advances that are incorporated in the CPT manual?

The guidelines that are at the beginning of each section.

Where is specific coding information about each section located?

HIPAA.

This act mandated the adoption of national uniform standards for electronic transmissions of financial and administrative health information?

The CMS-1500. (Used to be called the HCFA - name does not exist anymore changed to CMS).

Healthcare providers' are________based on the code submitted on a claim for procedure and services? Reimbursed.

5

Category I CPT codes have how many digits?

The CMS-1500. (Used to be called the HCFA - name does not exist anymore changed to CMS).

The universal health insurance form for submission of outpatient services is?

6.

How many main sections are in the CPT manual?

To identify a code that can never be used alone.

What is the function of an add-on code?

Increased reimbursement. (We are coding for comparative analysis, data for research and improved communication).

Which of the following is NOT a reason for the CPT coding system?

Variable (different).

The rules that govern coding in various healthcare settings are__________?

Provides additional information to the third-party payer about the CPT code. It does not change the CPT code.

What does a modifier do?

A code to use when you can't find a Category I or Category III code.

When should a coder use an unlisted procedure code?

Twice a year.

How often are Category III codes released?

Rerun.

According to the CPT manual, modifier 91 is not to be used when tests are _____to confirm initial results?

Emergency dept. of E/M Services. (E/M - Evaluation and Management pg. 7)

According to the E/M guidelines, time is not a component for the...?

If given a list of codes, it would be a code that has a plus sign in front of it. (Just look up the codes in the tabular or pg. 602 Appendix D that has all the add-on codes).

Which code is an add-on code?

Inpatient setting (Use the procedures in the back of ICD-9-CM)

Level II codes are not used in what type of setting?

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